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CLINICAL STATEMENTS AND GUIDELINES August 29, 2023 Circulation. 2023;148:e9–e119. DOI: 10.1161/CIR.0000000000001168 Virani et al 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Chronic Coronary Disease Guideline interventions. Observational studies suggest that clinicians may inaccurately estimate the burden of ischemic symptoms,19–21 which can lead to under-22 or overtreatment.21 Validated patient-reported disease-specific health status measures (eg, 7-item Seattle Angina Questionnaire31) may help to reliably quantify the burden of CCD symptoms and reduce variation in assessment among clinicians.23 Furthermore, patient-reported disease-specific health status instruments also measure how the patient’s angina affects their QOL, which should be an important component of the treatment decision process. Although several studies showed deficiencies with clinician estimation of patient’s symptoms, no studies show an improvement in quality of care or outcomes with routine use of patient-reported measures in clinical care. 4.1.1 Team-Based Approach Recommendation for Team-Based Approach Referenced studies that support the recommendation are summarized in the Online Data Supplement. COR LOE Recommendation 1 A 1 In patients with CCD, a multidisciplinary team- based approach is recommended to improve health outcomes, facilitate modification of ASCVD risk factors, and improve health service utilization.*1–13 *Modified from the 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease.14 Synopsis A patient-centered, team-based approach that focuses on shared decision-making is essential to monitoring and managing patients’ CCD symptoms throughout their disease course. These recommendations apply to all aspects of clinical practice for long-term management of CCD. A team-based approach can effectively be applied to nearly all aspects of CCD management and care. Continuous communication among the care team, the patient, and any caregivers is essential to optimize outcomes and meet patient needs. Figure 5 reflects the interconnectedness of the patient and caregiver to the care team and the care team members to each other. Components of the health care team include but are not limited to: physicians; nurse practitioners; physician assistants; nurses and nursing assistants; pharmacists; dietitians; exercise physiologists; physical, occupational, and speech therapists; psychologists; and social workers. Recommendation-Specific Supportive Text 1 RCTs and systematic reviews with meta-anal- ysis show that a patient-centered, multidisciplinary, team-based approach can improve patient self-efficacy, health-related QOL, and ASCVD risk factor management compared with usual care in patients with CCD who also Figure 4. Domains to Consider When Seeing a Patient With CCD. CCD indicates chronic coronary disease; CV, cardiovascular; QOL, quality of life; and SDOH, social determinants of health. Downloaded from http://ahajournals.org by on October 7, 2026