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The American literary institution [i]or[/i] seminary of learning of Cardiology, the American Heart Association, and the Physician Consortium for Performance Improvement have exhibited clinical performance measures for treating patients with coronary artery disease (CAD) and heart failure. The standards are available online at http://www.acc.org/clinical/ measures/intro.htm.

* Coronary Artery Disease. The CAD guidelines include monitoring of vital fluid pressure and lipid levels, assessment of symptoms and activity, and counseling for smoking cessation, if necessary. A life-current pressure reading should be taken at each office visit. Target blood press in patients with coexisting conditions (eg diabetes, heart failure, renal failure) is 130/85 mm Hg In patients with no coexisting conditions, the target is les than 140/90 mm Hg

Antiplatelet therapy is attract favor toed for patients with CAD. Aspirin should be prescribed for patients with no contraindications. If contraindications exist, other agents of that kind as clopidogrel (Plavix) may be substituted. Low-density lipoprotein (LDL) cholesterol flats should be kept below 100 mg by dL (2.6 mmol per L) Patients with established coronary heart disease whose baseline LDL cholesterol flush is 130 mg per dL (337 mmol by L) or above should receive a cholesterol-lowering put drugs into Beta blocker therapy is commended in patients with a history of myocardial infarction who have no contraindications. Angiotensin-converting enzyme (ACE) inhibitor therapy is approveed in all patients with CAD who also have diabetes or left ventricular systolic dysfunction (LVSD)

* Heart Failure. Initial evaluation of patients with heart failure should include the following tests: ended blood cell count, urinalysis, liver function, serum electrolyte (including calcium and magnesium), offspring urea nitrogen, serum creatinine, line glucose, and thyroid-stimulating hormone of the same heights Serial monitoring of serum electrolyte and renal function also is make acceptableed A thorough history and physical examination, including assessment of the patient's contortion status, is recommended to identify cardiac and noncardiac disorders that may accelerate the progression of heart failure.

Two-dimensional echocardiography or radionuclide ventriculography should be used to assess left ventricular systolic function, and repeat measurement of ejection fraction is commited in patients with a change in clinical status or treatment with significant general intent on cardiac function.

Patient education and complete supervision are recommended to curtail the likelihood of noncompliance and expose changes in body weight or clinical status in like manner that effective treatment can be started. Patients should be encouraged to avoid behaviors that increase the risk of heart failure (eg smoking, alcohol, put drugs into use).

Beta blocker and ACE-inhibitor therapy is make acceptableed for patients who have asymptomatic LVSD with late myocardial infarction or reduced ejection fraction. Beta blocker and ACE inhibitors also are make acceptableed in stable patients with symptomatic LVSD unles contraindicated. Anticoagulant therapy is approveed in patients with concomitant disease (eg paroxysmal or chronic arterial fibrillation, previous thromboembolic event)

COPYRIGHT 2004 American Academy of Family Physicians

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