p.5 抽出テキスト

CLINICAL STATEMENTS AND GUIDELINES

Circulation. 2023;148:e9–e119. DOI: 10.1161/CIR.0000000000001168 August 29, 2023

Virani et al 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Chronic Coronary Disease Guideline

1 INTRODUCTION

1.1 Methodology and Evidence Review

The recommendations listed in this guideline are, whenever possible, evidence based. An initial extensive evidence review—which included literature derived from research involving human subjects, published in English, and indexed in MEDLINE (through PubMed), EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline—was conducted from September 24, 2021, to May 2022. Key search words included but were not limited to the following: AHA/ACC Clinical Practice Guidelines; acute coronary syndrome; angina; cardiac rehabilitation; cardiovascular diseases; coronary artery disease; coronary disease; diabetes; type 2 diabetes; diet; diet therapy; dietary supplements; drug therapy; dual antiplatelet therapy; factor Xa inhibitors; hypertension; outcomes; quality of life; secondary prevention; therapy. Additional relevant studies, which were published through November 2022 during the guideline writing process, were also considered by the writing committee and added to the evidence tables when appropriate. The final evidence tables are included in the Online Data Supplement and summarize the evidence used by the writing committee to formulate recommendations. References selected and published in the present document are representative and not all-inclusive. The ACC and AHA have acknowledged the importance of value in health care to include development of cost–value statements for clinical practice recommendations. Available cost-effectiveness data were determined to be sufficient to support 9 specific recommendations in this guideline (Section 4.2.6, “Lipid Management”; Section 4.2.8, “SGLT2 Inhibitors and GLP-1 Receptor Agonists”; Section 5.1, “Revascularization”; and Section 8.1, “Cost and Value Considerations”). As a result, a Level of Value was assigned to those recommendations on the basis of the “ACC/AHA Statement on Cost/Value Methodology in Clinical Practice Guidelines and Performance Measures,”1 as shown in Table 1. Available quality-of-life (QOL) data were deemed to be insufficient to support specific recommendations in this guideline.

1.2 Organization of the Writing Committee

The writing committee consisted of general cardiologists, interventional cardiologists, cardiovascular surgeons, cardiac imaging experts, advance practice nurses, clinical pharmacists, health economists, and lay/patient representatives. The writing committee included representatives from the AHA, ACC, American College of Clinical Pharmacy (ACCP), American Society for Preventive Cardiology (ASPC), National Lipid Association (NLA), and Preventive Cardiovascular Nurses Association (PCNA). Appendix 1 of the current document lists writing committee members’ comprehensive and relevant RWI. 1.3 Document Review and Approval

This document was reviewed by 2 official reviewers each nominated by the ACC and AHA; 1 reviewer each from the ACCP, ASPC, NLA, PCNA, and 6 individual content reviewers. Reviewers’ RWI information was distributed to the writing committee and is published in this document (Appendix 2). This document was approved for publication by the governing bodies of the ACC and the AHA and was endorsed by the ACCP, ASPC, NLA, PCNA, and Society for Cardiovascular Angiography and Interventions.

1.4 Scope of the Guideline

The scope of the “2023 AHA/ACC/ACCP/ASPC/ NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease” (referred to hereafter as the “2023 CCD guideline”) is to provide an update to and consolidate new evidence since the publication of the “2012 ACCF/AHA/ACP/AATS/ PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease”3 and the “2014 ACC/AHA/AATS/PCNA/ SCAI/STS Focused Update of the Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease” and will replace these prior guidelines.4 This current document provides a patientcentered approach to management of chronic coronary disease (CCD) incorporating the principles of shared decision-making, social determinants of health (SDOH), and team-based care. Where applicable and based on availability of cost-effectiveness data, value recommendations are also provided for clinicians.

Table 1.  Level of Value for Clinical Guideline Recommendations* Level of Value for Clinical Guideline Recommendations* Level of Value High value: Better outcomes at lower cost or ICER <$50 000 per QALY gained Intermediate value: $50 000 to <$150 000 per QALY gained Low value: ≥$150 000 per QALY gained Uncertain value: Value examined but data are insufficient to draw a conclusion because of no studies, low-quality studies, conflicting studies, or prior studies that are no longer relevant Not assessed: Value not assessed by the writing committee Proposed abbreviations for each value recommendation: Level of Value: H indicates high value; I, intermediate value; L, low value; U, uncertain value; and NA, value not assessed. *Figures used in this table are based on US GDP data from 2012 and were obtained from WHO-CHOICE Cost-Effectiveness Thresholds.2 GDP indicates gross domestic product; ICER, incremental cost-effectiveness ratio; QALY, quality-adjusted life-years; and WHO-CHOICE, World Health Organization Choosing Interventions that are Cost-Effective. Reproduced with permission from Anderson JL, et al.1 Copyright 2014 American Heart Association, Inc., and the American College of Cardiology.

Downloaded from http://ahajournals.org by on October 7, 2026