Chronic Coronary Disease Guideline: E1 Approach to Treatment
Chronic Coronary Disease Guideline: E1 Approach to Treatment
Dr. Salim Virani, professor of medicine at Aga Khan University and cardiologist at Texas Heart Institute, and Dr. Kristin Newby, professor of medicine at the Duke University School of Medicine, served together as co-chairs for the 2023 American Heart Association and American College of Cardiology Guideline for Chronic Coronary Disease. These guidelines aim to give the best possible recommendations for treating CCD and should be valuable for anyone dealing with these patients: cardiologists, primary care physicians, nurse practitioners, physicians’ assistants, even pharmacists and other allied health professionals. In this episode, Dr. Virani and Dr. Newby focus on the guideline’s high level approach to treatment, which emphasizes patient-centered care, a team based approach, and a consideration of social determinants of health. Learn more about the guideline: bit.ly/3K3qSMt
0:00 - Intro
4:31 - Classifying recommendations
6:44 - Defining CCD
10:30 - Impact of CCD / epidemiology
11:55 - Approach to treatment
21:56 - Social determinants of health
Content
0 -> foreign
0.68 -> [Music]
3.179 -> welcome to the American Heart
4.799 -> Association statements and guidelines
6.6 -> podcast where we'll discuss clinical
8.7 -> practice guidelines and scientific
10.44 -> statements on various cardiovascular
12.42 -> disease and stroke topics
18.18 -> hello everyone
19.56 -> I am Saleem varani and I serve as Vice
22.08 -> Provost for research and professor of
24.18 -> medicine at the agathan University in
26.519 -> Pakistan I am also a staff cardiologist
29.58 -> at the Texas Heart Institute and an
32.46 -> Adjunct professor at Baylor College of
34.559 -> Medicine in Houston Texas in my clinical
37.739 -> practice I am a non-invasive
40.2 -> cardiologist with a special focus on
43.02 -> preventive Cardiology
45.36 -> and I'm Kristen Newby I'm a professor of
47.94 -> medicine in the division of Cardiology
49.739 -> and a faculty member at the Duke
51.36 -> Clinical Research Institute at Duke
53.579 -> University School of Medicine
56.36 -> so we are so excited today to be talking
59.46 -> about the 2023 American Heart
62.34 -> Association and American College of
64.26 -> Cardiology guideline for the management
66.54 -> of patients with chronic coronary artery
68.939 -> disease now I must say at the beginning
71.34 -> of this podcast that this is a group
74.159 -> effort uh in fact we had a dedicated
77.34 -> group of 27 volunteers from various
80.52 -> partner organizations including patient
83.46 -> Representatives who were part of this
85.619 -> effort and I had the honor of serving as
88.56 -> the chair for this particular guideline
91.799 -> and I served with Dr varani as the
94.439 -> co-chair of the guidelines and I'm
96.78 -> excited to talk with you today about
98.96 -> where we settled on our recommendations
104.64 -> so uh as
106.5 -> all of you who actually look at the
108.54 -> guideline will notice that this
110.759 -> guideline provides and evidence-based
112.979 -> and patient-centered approach to the
115.14 -> management of patients with chronic
116.88 -> coronary artery disease
118.5 -> now as we'll discuss later uh chronic
121.92 -> coronary artery disease or or chronic
123.84 -> coronary disease CCD is a major problem
127.099 -> both in terms of scope and severity and
131.099 -> therefore for clinicians this guideline
133.62 -> is an extremely important guideline to
136.2 -> follow in their practice now this
138.48 -> guideline aims to provide the clinicians
140.58 -> with the best available recommendations
143 -> on how to address CCD now now we'll
146.459 -> start from the big picture talking about
148.5 -> Concepts in the management of patients
150.54 -> with CCD but then during this podcast
153.599 -> we'll get into the granular details
156.12 -> about which drugs and treatments to use
159.66 -> in patients with chronic coronary artery
162.06 -> disease and in various scenarios
166.44 -> so we think this guideline will be
168.42 -> really valuable for anyone who deals
170.519 -> with chronic coronary disease patients
172.68 -> and that is everyone from cardiologists
175.44 -> to primary care physicians nurse
178.08 -> practitioners Physicians assistants even
181.16 -> Pharmacists and other Allied health
184.8 -> professionals so we intend this to be
187.56 -> very broad very usable easily accessible
191.04 -> document
194.4 -> now you know the way we have uh this
197.94 -> podcast we have three episodes so over
200.76 -> the three next three episodes we're
202.8 -> going to be talking about quite a few
205.14 -> things we'll try to cover a good chunk
206.879 -> out of these guidelines uh these
209.099 -> guidelines as you will notice are very
210.9 -> extensive just because there's too much
212.64 -> to cover when it comes to management of
214.68 -> patients with chronic coronary disease
216.659 -> so the first podcast which is the one
219.9 -> that you're listening to right now and
221.28 -> watching we will start out by defining
224.099 -> what coronary chronic coronary disease
225.9 -> is what is a general approach to
228.659 -> treatment of patients with chronic
230.94 -> coronary disease in the second podcast
233.4 -> we'll talk about Concepts in risk
236.099 -> assessment of patients with chronic
238.08 -> coronary disease as well as various
240.78 -> recommendations that are related to
242.879 -> Lifestyle therapies and in the final
245.4 -> episode we'll get into some more details
248.28 -> about specific therapies as well as
251.099 -> treatments as well as some special
253.379 -> populations that we all need to keep in
255.959 -> mind while we're treating patients with
258.54 -> chronic coronary disease now uh
260.82 -> Christian uh can you tell us a little
262.919 -> bit about how we classify
264.66 -> recommendations when it comes to
266.04 -> guidelines in general
267.6 -> yeah happy to do that this is really
269.759 -> important before we get into the meat of
271.62 -> the guidelines to understand how we
273.72 -> classify recommendations
275.82 -> so keep these um as we go through these
278.82 -> keep these classifications in mind
281.16 -> because we are going to refer to them
283.259 -> throughout these three podcasts so we
285.78 -> have three main classifications of
288.6 -> recommendations so class one
290.759 -> recommendations are our strongest
293.16 -> recommendations we have very good
296.34 -> confidence that the benefit of what
298.979 -> we're recommending outweighs the risk
301.02 -> and they have the strongest evidence
302.82 -> clinical trials meta-analyzes and
305.699 -> observational studies behind them
307.979 -> Class 2 recommendations are a notch
310.979 -> below class 1 recommendations but
313.32 -> they're still fairly strong and are
315.72 -> things that are worth considering as
317.52 -> we're confronting patients with chronic
319.32 -> coronary disease there are two
321.84 -> subcategories of class two
324.12 -> recommendations class two a is
327.66 -> recommendations in which the benefit is
330.18 -> still greater than risk and we think
331.979 -> it's reasonable to incorporate it into
334.5 -> our treatment for our patients
337.86 -> class 2B recommendations are a little
340.259 -> weaker the benefit may or may not exceed
343.38 -> the risk or there may be additional
345.539 -> risks so the evidence doesn't
348.84 -> necessarily support that we should do
350.82 -> that every time but there are still
352.199 -> things that we should keep in mind and
355.02 -> consider in in certain circumstances
357.5 -> class three recommendations are also
360.18 -> very important class three
361.38 -> recommendations are the things that we
363.6 -> recommend against doing and we do that
366.78 -> either because they have been shown to
369.12 -> cause harm or because there is no
372.479 -> benefit so there are two types of class
374.639 -> 3 recommendations harm or lack of
377.759 -> benefit so these are again these are
380.46 -> going to be important as we think about
382.58 -> what we're going to tell you here over
384.9 -> the coming podcast so keep these in mind
388.86 -> thank you Christian uh that's extremely
391.139 -> important now of course we need to know
393.6 -> what recommendations mean when we talk
395.94 -> about a class one recommendation class
398.039 -> 2A 2B and class 3 recommendations the
401.46 -> other thing that's extremely important
403.02 -> is to Define what chronic coronary
406.259 -> disease means when we're talking about a
408.06 -> patient and what this guideline actually
410.16 -> entails and what this guideline does not
411.9 -> entail so this guideline pertains to
415.199 -> outpatient management of patients with
417.539 -> chronic Corner disease now these
419.639 -> patients with chronic coronary disease
421.319 -> are defined as patients who are
424.08 -> discharged after being admitted for an
426.72 -> acute coronary syndrome event or after
429.319 -> revascularization procedure or after
433.52 -> stabilization of all acute
436.08 -> cardiovascular issues so all of these
438.12 -> things have to be met they have to be
440.52 -> stable they have to be in the outpatient
442.68 -> setting the other group of patients who
445.919 -> will be classified as CCD which this
448.08 -> guideline will apply to are patients
450.479 -> with left ventricular systolic
452.039 -> dysfunction who are known or suspected
454.86 -> to have coronary artery disease or those
457.8 -> with established cardiomyopathy but it
459.96 -> is deemed to be of ischemic in origin
462.18 -> the third group is patients with stable
464.88 -> angina symptoms or ischemic equivalents
467.46 -> such as dyspnea or arm pain with
469.319 -> exertion who are medically managed and
471.84 -> they can be managed with or without
473.58 -> positive results of an imaging test
476.58 -> we can also have patients with angina
478.74 -> symptoms and evidence of coronary
480.86 -> vasospasm or microvascular angina and
484.56 -> last but not the least patients who are
487.259 -> diagnosed with chronic coronary disease
489.259 -> based solely on the results of a
491.699 -> screening study that could be a stress
493.62 -> test coronary CTA and then the treating
497.039 -> clinician concludes that the patient has
500.22 -> a chronic coronary disease so any of
502.979 -> these uh five conditions that I
506.039 -> mentioned to you would constitute
508.139 -> chronic coronary disease now there are a
510.06 -> few nuances here that clinicians should
512.339 -> also keep in mind first this chronic
515.64 -> coronary disease population is a very
517.44 -> heterogeneous group as you can see from
519.599 -> the five groups of patients I mentioned
522 -> to you the risk of future cardiovascular
524.7 -> event is not the same for a patient who
526.98 -> has stable angina the risk is different
529.38 -> much lower compared to a patient who
532.62 -> recently was admitted for an acute
534.779 -> coronary syndrome although they're
536.399 -> stabilized now
537.72 -> second when we talk about treatment of
540.06 -> these patients so of course we all as
542.88 -> clinicians are always thinking about how
544.74 -> to improve cardiovascular outcomes but
547.08 -> at the same time symptom relief and
550.38 -> Improvement in quality of life
552.6 -> are extremely important considerations
555 -> in these patients the third important uh
559.459 -> aspect of this is
561.66 -> that we believe that a lot of this
564.24 -> management for chronicorn disease can be
567.36 -> performed effectively in a primary care
569.7 -> setting so it does not mean that only
572.42 -> cardiologists or Cardiology clinicians
574.98 -> are the ones who should be taking care
576.839 -> of patients with chronic coronary
578.16 -> disease the last important point that we
580.98 -> acknowledge is that there is a Continuum
584.459 -> of risk between primary and secondary
586.38 -> prevention the classic clinical scenario
588.839 -> that clinicians may be faced with are
591.3 -> patients with significant coronary
593.58 -> artery calcium that's noted on a a
596.1 -> cardiac CT or a chest CT which was
598.14 -> performed for any other indication now
601.08 -> these patients of course have higher
603.06 -> risk of having a cardiovascular event
604.8 -> compared to our classic primary
607.38 -> prevention patients but these patients
609.899 -> for example those with high coronary
611.519 -> artery calcium score are covered in the
614.279 -> 2018
615.74 -> cholesterol guidelines as well as the
618.06 -> 2019 primary prevention guidelines so we
620.399 -> would recommend that emissions follow
623.519 -> those guideline documents when it comes
625.92 -> to patients with extensive subclinical
629.04 -> atherosclerosis
631.74 -> so the scope of chronic coronary disease
635.899 -> is is huge so it's a big issue for us
639.959 -> here in the United States as well as
643.14 -> well as around the world there are about
645.06 -> 20 million Americans who are living with
648.36 -> chronic coronary disease that ranges
651.36 -> from as you heard documented coronary
654.54 -> disease to Chronic stable angina that is
657.6 -> presumed due to underlying coronary
660 -> disease it's a little bit more common in
664.14 -> men than women considering all types of
667.019 -> chronic coronary disease and coronary
670.2 -> disease increases with age but a few
673.74 -> comments with respect to race and
676.32 -> ethnicity so we know that white men have
678.959 -> higher prevalence of coronary heart
680.88 -> disease myocardial infarction and angina
683.399 -> pectors than all other race sex and
686.519 -> ethnicity groups black women have a
689.579 -> comparable prevalence of angina
692.399 -> not necessarily documented coronary
696.06 -> disease but angina pectoris with that of
698.579 -> white men and Asian women have the
701.1 -> lowest prevalence of coronary heart
703.019 -> disease myocardial infarction and angina
705.54 -> pectoris
707.519 -> thank you Christian for providing that
710.04 -> uh good overview of epidemiology of
713.7 -> coronary disease now when it comes to
717.24 -> approach to treatment of patients with a
719.88 -> chronic coronary disease one major area
722.88 -> that we wanted to emphasize in this
725.579 -> guideline is the overall approach to
727.8 -> treatment now of course from a big
730.56 -> picture perspective
732 -> the ultimate goal of treatment are R3
735.6 -> first is to prolong survival to reduce
739.2 -> symptoms and improve quality of life now
742.62 -> while we're trying to address these
744.779 -> three aspects the other treatment goal
747.36 -> also includes that we want to reduce
749.7 -> cardiovascular events whether those are
752.42 -> events related to coronary tree or or
756.32 -> other vascular beds as well so those are
760.38 -> the treatment goals which are Beyond
763.32 -> just improving symptoms or quality of
765.899 -> life but also improving survival and
768.6 -> reducing non-fatal events as well now
771.959 -> why we are doing that it is extremely
774.66 -> important that we keep into
776.94 -> consideration what are the patient
779.279 -> preferences we all know that coronary
782.16 -> disease patients I don't know a lot of
783.66 -> medications
784.62 -> and it's really up to the patient to
787.8 -> decide what is important for them so
790.139 -> that preference needs to be at front and
792.36 -> center
793.2 -> we need to keep in mind what are the
795.779 -> benefits versus risks associated with
798 -> various treatments as well as procedures
799.98 -> what are possible complications
802.019 -> at the same time it is extremely
804.779 -> important to be very mindful of cost
807.2 -> cost to the individual patient we know
810.18 -> that out of pocket cost is a very
813.18 -> important determinant of how we're
815.88 -> dealing our patients are to various
817.56 -> therapies that we prescribe as well as
820.079 -> cost to the healthcare system because we
821.76 -> know we live in a system where therapies
824.22 -> are expensive and our patients need a
826.8 -> lot of therapies and chronic coronary
828.54 -> disease is one such symptom complex we
831.839 -> have other medical conditions that are
834.72 -> also you know things that we need to
836.639 -> take care of and then last but not the
839.16 -> least how do we leverage the entire CV
843.12 -> team because as you will see uh and here
845.7 -> during this podcast that there are a lot
848.16 -> of things that we need to address and it
850.079 -> will be very difficult for just one
852.48 -> member of the CV team to address all of
855.54 -> these aspects in the management of
858.36 -> chronic Corner disease so with that I'll
860.639 -> pass it over to Christian and Christian
861.959 -> if you can talk a little bit about
864.68 -> various other considerations that we
867.24 -> have we should have uh while we are
869.519 -> looking at the overall treatment of of
871.38 -> these patients that would be very very
873.54 -> important for us
875.279 -> so sure the first step in treatment
877.8 -> really is accurate risk assessment and
881.579 -> we're going to talk a fair bit about
883.019 -> that but there are certain categories of
885.6 -> things that have not always been highly
889.26 -> incorporated into our risk assessment
891.42 -> and those are things like social
893.399 -> determinants of health and there's a
896.339 -> large emphasis as you'll see as we go
898.26 -> through this on
899.959 -> assessing and acting on social
903 -> determinants of health so things like
905.36 -> insurability health literacy uh the
909 -> environment in which the patient may
910.74 -> live we also want to emphasize
913.82 -> engaging the patient so the patient has
916.86 -> to be informed and participating in
920.519 -> decision making for our treatments to be
923.36 -> implemented and effective for them and
927.36 -> then as Dr varani mentioned there needs
929.16 -> to be a team-based approach where
931.5 -> patients and clinicians are working
934.079 -> together to to navigate treatment of
936.959 -> their chronic coronary disease so what
939.42 -> do I mean by a team-based approach so
942.12 -> when we talk about a team-based approach
945.32 -> this is one of the really important kind
948.36 -> of critical updates to this guideline so
951 -> if we're thinking about treating
952.62 -> patients with chronic coronary disease
955.26 -> and we have a class one recommendation
957.779 -> that the guidelines recommends we have
961.38 -> to consider
962.76 -> not only what I as a cardiologist might
966.06 -> think but if there is another health
969 -> care provider that's important to
971.459 -> application for example even the primary
973.92 -> care physician and Interventional
975.72 -> cardiologist
977.72 -> we need to have them engaged we want
980.699 -> everybody's opinion in making these
982.86 -> decisions and then
984.36 -> most importantly the patient is at the
987.3 -> center of that approach so the patient
990 -> again emphasizing patient engagement
992.22 -> that we're thinking about the patient as
995.699 -> our primary goal to help them live a
999.12 -> longer and healthier life so the team as
1001.88 -> we mentioned earlier that can be
1003.56 -> Physicians that can be nurse
1005.24 -> practitioners physician assistants it
1007.82 -> includes our nurses and nursing
1009.62 -> assistants pharmacists dietitians the
1013.279 -> exercise physiologists as we talk about
1015.5 -> cardiac rehab
1017.36 -> physical occupational or speech
1019.699 -> therapists may be relevant and
1022.22 -> psychologists and social workers and I
1024.319 -> would also include in this the patient's
1026.78 -> family their nuclear support that is one
1030.319 -> of the key social determinants
1034.52 -> and and then just building on what Dr
1036.559 -> Newby just talked about right she
1038.78 -> mentioned one very important message
1041.059 -> here which was that patient themselves
1044.439 -> are an important member of the team so
1047.179 -> we need to make sure that patients are
1050 -> front and center when it comes to
1051.919 -> decision making as well as
1053.84 -> implementation of these therapies right
1055.64 -> we know from randomized control trials
1058.22 -> as well as systematic reviews with
1060.14 -> meta-analyzes that a patient-centered as
1064.039 -> well as multi-disciplinary team-based
1066.559 -> approach can improve patient
1068.84 -> self-efficacy health related quality of
1071.419 -> life as well as risk factor management
1073.82 -> we have quite a few studies where we
1076.16 -> have a team-based approach it
1078.2 -> outperforms approach when it's only one
1081.44 -> clinician who's taking care of the
1083.24 -> patient it's no surprise because there's
1084.74 -> so many things to cover when we're
1086.12 -> taking care of patients with chronic
1087.5 -> coronary disease so that's one thing the
1090.559 -> second is patient education is extremely
1094.1 -> important because we know as you will
1096.34 -> see when we discuss more aspects of this
1100.039 -> guideline that social determinants of
1101.84 -> Health are extremely important we have a
1103.94 -> lot of lifestyle changes that we
1105.44 -> recommend we have a lot of things
1107.24 -> related to symptom management therefore
1109.94 -> patient education and that education
1112.34 -> does not happen during one visit it is
1115.52 -> just an ongoing phenomena that happens
1117.919 -> on every visit
1119.419 -> and it is extremely important to do that
1122.48 -> education at every visit to ensure that
1125.66 -> our patients are making informed
1127.46 -> decisions both in terms of what is
1129.86 -> important to them so we can focus on
1131.96 -> them and then it improves their
1133.94 -> self-efficacy to be able to follow what
1136.88 -> is being recommended because we know
1138.62 -> that adherence to both lifestyle
1140.96 -> therapies as well as medical therapies
1143.059 -> is extremely low when it comes to
1145.28 -> patients with any any chronic condition
1147.28 -> including patients with chronic coronary
1149.66 -> disease and then the other aspect of
1152.179 -> this is that when we educate our
1155.059 -> patients when we put them front and
1157.46 -> center of every decision making that is
1161.24 -> what will lead to Shared decision making
1163.1 -> now whether that is
1164.72 -> uh in terms of what therapies to use
1167.96 -> what treatment strategy to use and the
1171.38 -> end goal of that shared decision making
1173.78 -> is not receipt of a therapy or a
1177.14 -> treatment strategy but it's the quality
1179.66 -> of that decision that is made between
1181.64 -> the clinician and the patient and this
1184.16 -> becomes extremely important when there
1186.559 -> is a significant risk with a therapy or
1189.86 -> there is a trade-off that exists between
1192.5 -> the benefit and risk and that's why it
1195.799 -> is extremely important to keep patients
1198.559 -> at front and center the other aspect of
1201.14 -> this that I would like to emphasize when
1202.76 -> it comes to General management
1204.62 -> principles for patients with chronic
1206.66 -> coronary disease is to always keep in
1209.179 -> mind what is the out-of-pocket cost for
1211.88 -> our patients whenever we are initiating
1214.22 -> a new medication or even continuing a
1216.86 -> medication and this should be done at
1219.2 -> every visit the reason for this is what
1221.96 -> we discussed earlier that non-adherence
1224.78 -> to Medical therapy as well as lifestyle
1227 -> is extremely common in these patients
1229.7 -> like it is for any chronic disease so as
1232.58 -> long as we are talking about
1233.96 -> out-of-pocket expenses it will allow us
1237.38 -> to address one of the most important
1239.78 -> reason why our patients may not be able
1243.559 -> to remain adherent to what we are
1246.02 -> recommending to them
1248.299 -> so sleep just to follow on that um you
1251.12 -> know I think we we are really
1252.62 -> emphasizing this team-based care and
1254.72 -> shared decision making that includes the
1257.48 -> patient and their their support system
1260 -> we know that using this approach can it
1265.46 -> really improve as you said adherence but
1269.12 -> also behavioral changes like dietary
1272.6 -> intervention stopping smoking
1275.36 -> um and and weight loss to name a few we
1278.9 -> also know that a team-based approach
1280.7 -> when we when we engage across the
1284 -> spectrum of individuals that contribute
1287 -> to Patient Care and the patients
1290.659 -> themselves we can be more cost effective
1293.36 -> we can reduce things like emergency
1295.46 -> department visits or un other unplanned
1298.64 -> Health Service utilization and prevent
1301.82 -> cardiovascular complications which is
1304.1 -> our entire goal so how do we help the
1307.1 -> patient live that longer healthier life
1309.74 -> and do it at a cost that's reasonable
1312.14 -> not only to the patient but to the
1313.82 -> Health Care system
1315.919 -> so these are all very important Concepts
1318.14 -> when we talk about General management
1320.6 -> principles for patients with coronary
1323 -> disease now one other aspect that you
1325.58 -> already heard uh Dr Newby and and I
1328.34 -> talked about was keeping in mind social
1330.98 -> determinants of Health now these are
1333.679 -> extremely important determinants to
1335.299 -> consider in treatment because there's a
1337.22 -> lot of evidence that the impact
1339.26 -> cardiovascular outcomes now some of
1341 -> those are probably direct determinants
1342.919 -> and some of those are indirect because
1344.72 -> our patients may not be able to adhere
1347.24 -> to the recommendations that we are
1348.799 -> making now you know these are
1351.08 -> determinants that are related to health
1352.82 -> care access
1353.919 -> economic stability or lack thereof as
1357.559 -> well as what is the social context uh as
1360.44 -> as far as a particular patient is
1362.36 -> concerned so you will notice that
1364.28 -> there's a strong recommendation that
1366.919 -> these should be routinely assessed by
1368.96 -> clinicians as well as the care team and
1372.02 -> then this should be part of our informed
1374.419 -> decision uh making as well now these
1378.08 -> social determinants of Health in terms
1380.6 -> of what we should screen for when we are
1383.36 -> talking to our patients about our
1385.22 -> recommendations these include assessment
1387.98 -> of mental health mental well-being
1390.159 -> psychosocial stressors health literacy
1393.08 -> is part of it uh social cultural
1394.94 -> influences for example uh their language
1397.179 -> religious affiliation what is the
1400.52 -> financial strength that our patient may
1402.08 -> have which will of course affect out of
1403.88 -> pocket expenses Transportation related
1406.28 -> issues uh things related to patients
1408.799 -> Insurance status uh barriers or to
1411.62 -> adherence of a heart healthy lifestyle
1413.179 -> for example uh issues related to food
1415.76 -> security what are things related to
1418.039 -> neighborhood or environmental exposures
1419.72 -> right some of these neighborhood related
1421.28 -> factors are extremely important when we
1423.5 -> are recommending physical activity then
1426.14 -> what are the social support systems that
1429.32 -> are available to our patients so all of
1431.78 -> these things are extremely important
1434.24 -> when we are talking about social
1436.1 -> determinants of Health now one other
1438.2 -> point I would make here is for those
1440.179 -> clinicians who are watching this podcast
1443.08 -> is to refer I would refer them to figure
1446.179 -> six of our guideline that actually very
1449.12 -> nicely lays out a lot of these social
1451.88 -> determinants that we talked about but in
1454.64 -> addition also talks about what are the
1457.58 -> strategies that we as connections can
1460.7 -> employ to address those social
1462.74 -> determinants of Health
1464.539 -> so you know just to follow on uh from
1467.6 -> that social determinants of health and
1469.94 -> and assessing social determinants of
1472.039 -> Health it is so um important but it can
1474.98 -> also be challenging so just as one
1477.919 -> example uh we we know that uh the
1481.34 -> neighborhood environment is important in
1483.5 -> a number of ways the cardiovascular
1485.24 -> disease and and one of those is for
1487.88 -> example environmental exposure to air
1489.86 -> pollution you know it's very difficult
1492.039 -> to counsel a patient regarding
1496.179 -> environmental exposures because it may
1498.44 -> not be within their means or or feasible
1501.86 -> for them to change their environment but
1504.38 -> we can talk with them about how they can
1506.539 -> minimize their exposures and include
1509.9 -> that as part of their treatment plan
1513.2 -> and if we don't do this screening we
1516.14 -> can't help individuals find the
1519.62 -> appropriate care teams or
1521.24 -> community-based resources that are going
1523.94 -> to be important to them to help minimize
1526.779 -> their risks from chronic coronary
1529.7 -> disease
1532.22 -> so uh thank you Christian uh so as as
1535.279 -> our listeners would have would have
1536.72 -> noticed what we have done in this
1538.88 -> particular podcast the first of three is
1541.46 -> to give you an overview of the uh
1543.919 -> chronic coronary disease guideline you
1546.08 -> know uh what this guideline includes we
1548.9 -> talked about uh the the class of
1551.299 -> recommendations we talked about General
1553.34 -> approach to treatment why it is
1555.799 -> important to make it patient-centered
1558.02 -> team based why we should look at Social
1560.72 -> determinants of Health I we hope that
1563.36 -> you will find this helpful as you uh
1565.64 -> treat these patients now in our second
1568.22 -> podcast we will talk about risk
1570.44 -> stratification and most importantly why
1574.159 -> are lifestyle recommendations so
1576.5 -> important for patients with chronic ore
1578.9 -> disease uh we thank you for listening to
1581.419 -> this first episode and uh be sure and
1584.299 -> not to miss the following two to get the
1586.52 -> full overview of this guideline so thank
1588.32 -> you for your time
1590.26 -> [Music]
1595.52 -> no guideline being released by the
1597.26 -> American Heart Association any and all
1599.48 -> personal stories and testimonies are
1601.159 -> that of the talent hosts and volunteers
1603.26 -> and are not reflective of any statements
1605.419 -> or position of the American Heart
1606.86 -> Association for a full manuscript of the
1609.38 -> guideline released please visit the
1611.24 -> official American Heart Association
1612.74 -> website at professional.heart.org
Source: https://www.youtube.com/watch?v=lOfKIIrssnI