The Effective Health Care Program of the Agency for Healthcare Research and Quality, or AHRQ, has released summary guides for clinicians and consumers that discuss adjunctive therapy options for patients with stable coronary heart disease.
The clinician guide(effectivehealthcare.ahrq.gov) summarizes the current clinical evidence regarding augmenting standard medical therapy for patients with stable ischemic heart disease with an angiotensin-converting enzyme inhibitor, or ACEI, and/or an angiotensin-II receptor blocker, or ARB.
The guides are based on information from a comparative effectiveness review(www.effectivehealthcare.ahrq.gov) prepared last year by the University of Connecticut/Hartford Hospital Evidence-based Practice Center.
The "Clinical Bottom Line" section of the clinician guide lists the following findings:
- Adding an ACEI to standard treatment reduces total mortality, as well as the incidences of nonfatal myocardial infarction, heart failure-related hospitalization and revascularization. However, the addition of an ACEI also increases the risk of syncope, cough and hyperkalemia.
- Adding an ARB to standard treatment for patients who cannot tolerate ACEIs reduces the combined end points of cardiovascular mortality, nonfatal myocardial infarction and stroke, but it increases the risk of hyperkalemia.
- Adding both an ACEI and an ARB to standard treatment provides no additional clinical benefit compared with adding an ACEI alone, and it increases the risk of hypotension, sudden fainting and renal impairment.
- Adding an ACEI or an ARB to standard treatment in a patient who is soon to undergo a revascularization procedure provides no additional clinical benefit compared with standard therapy alone and increases the risk of subsequent revascularizations and hypotension.
These potential benefits and harms are listed with level-of-confidence ratings in the guide.
The consumer guide(effectivehealthcare.ahrq.gov) provides plain-language information about stable coronary heart disease and helps patients understand the benefits and risks of these medications.