2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines

Salim S. Virani; L. Kristin Newby; Suzanne V. Arnold; Vera Bittner; LaPrincess C. Brewer

doi:10.1161/cir.0000000000001168

2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines

Salim S. Virani, L. Kristin Newby, Suzanne V. Arnold, Vera Bittner, LaPrincess C. Brewer, Susan Halli Demeter, Dave L. Dixon, William F. Fearon, Beverly Hess, Heather M. Johnson, Dhruv S. Kazi, Dhaval Kolte, Dharam J. Kumbhani, Jim LoFaso, Dhruv Mahtta...

Lippincott Williams & Wilkins (2023) • Volume 148, Issue 9

GuidelineGuidelinePDF AvailableGrade Eligible⚠️ Moderate Risk Flags

Overall Assessment

Strong Methodological Quality

Assessment created by PaperScorers Medical AI v0.1.0 on Dec 14, 2025

B+

83/100

Key Takeaways

•Team-based, patient-centred CCD care with SDOH and shared decisions (Top 10).
•Statins first-line; add ezetimibe/PCSK9 for very high risk; icosapent ethyl selective.
•Beta-blockers not for outcome benefit unless recent MI (≤1y) or LVEF ≤50%.
•Shorter DAPT often adequate post-PCI; consider P2Y12 monotherapy after 1–3 mo.
•SGLT2i/GLP-1RA recommended in CCD with T2D; SGLT2i for HFrEF regardless of diabetes.

Conclusion

Robust multisociety guideline updating CCD management with graded, cost-aware recommendations and practical algorithms.

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Quality Dimensions

Bias & Integrity

COI handling, outcome switching, selective reporting

B+80

Methods Rigour

Protocol clarity, sampling, controls

A-86

External Validity

Generalisability, setting, population

A-88

Transparency & Reproducibility

Data/code/materials availability, preregistration

B-72

Significance & Novelty

Contribution vs prior art; context if known

A92

Statistical Validity

Models, assumptions, multiplicity, CI priority

B78

Integrity & Transparency

Integrity checks

P-hacking risk?

?

None suspected

Signs of selective hypothesis testing or analysis choices that could inflate false positive rates.

Outcome switching?

?

None suspected

Evidence that primary outcomes were changed during or after the study, potentially distorting results.

Conflict of interest?

?

Review recommended

Authors have financial or other relationships that could bias research findings.

Data integrity issues?

?

None suspected

Concerns about the accuracy, completeness, or authenticity of the reported data.

Open science signals

Research data

?

Not applicable

Raw data used in the analyses is publicly available or accessible upon request.

Analysis code

?

Not applicable

Code or scripts used to analyze the data are shared for reproducibility.

Study materials

?

Not applicable

Protocols, questionnaires, and other materials are publicly available.

Premise

Primary Research Question

What is evidence-based management for patients with chronic coronary disease?

Hypothesis is Falsifiable

—Not specified

Guideline provides recommendations, not testable hypotheses.

PICO Framework

Population✓Yes

CCD outpatients including post-ACS after stabilisation; special populations covered.

Intervention✓Yes

Lifestyle, pharmacotherapy, revascularisation, rehab; graded recommendations.

Comparison✓Yes

Comparisons vs usual care/alternatives grounded in RCTs and meta-analyses.

Outcome✓Yes

Mortality, MACE, angina, QoL, bleeding, cost–value discussed.

Literature Positioning

Literature Review Balanced

Well covered

Synthesises RCTs, registries, SRs; links to related guidelines; COR/LOE cited.

Evidence: p. e13–e16; Table 2.

Research Gap Clearly Stated

Well covered

Section 8.2 lists evidence gaps and future research needs.

Evidence: p. e81–e82.

Stated Contribution Clear

Well covered

Updates and consolidates SIHD guidance with new evidence and cost–value notes.

Evidence: p. e9–e14 (Aim/Scope).

Study Provenance

Peer reviewed venueFunding disclosedConflict disclosure providedAffiliations listed

Authors & Affiliations

AHA/ACC Joint Committee with ACCP/ASPC/NLA/PCNA collaborators; multiple academic and clinical institutions.

Funding Statement

Guidelines sponsored by ACC/AHA without commercial support; volunteers’ time (stated).

Conflicts of Interest

Detailed author and reviewer RWIs disclosed; recusals noted (Appendix 1–2).

Peer Review

✓Published in Circulation and JACC with peer review; multisociety endorsement.

Evidence: p. e13; header; endorsement list.

Methodological Assessment

All design modules are marked as not applicable. Use the accordion below to review their details.

Modules without applicable checklist items (10)

These designs were fully marked as not applicable but remain available for reference.

Abstract

AIM: The “2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease” provides an update to and consolidates new evidence since the “2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease” and the corresponding “2014 ACC/AHA/AATS/PCNA/SCAI/STS Focused Update of the Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease.” METHODS: A comprehensive literature search was conducted from September 2021 to May 2022. Clinical studies, systematic reviews and meta-analyses, and other evidence conducted on human participants were identified that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. STRUCTURE: This guideline provides an evidenced-based and patient-centered approach to management of patients with chronic coronary disease, considering social determinants of health and incorporating the principles of shared decision-making and team-based care. Relevant topics include general approaches to treatment decisions, guideline-directed management and therapy to reduce symptoms and future cardiovascular events, decision-making pertaining to revascularization in patients with chronic coronary disease, recommendations for management in special populations, patient follow-up and monitoring, evidence gaps, and areas in need of future research. Where applicable, and based on availability of cost-effectiveness data, cost–value recommendations are also provided for clinicians. Many recommendations from previously published guidelines have been updated with new evidence, and new recommendations have been created when supported by published data.

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Study Overview

Study Design

Guideline

Primary classification used to evaluate this research.

Population

Adults with chronic coronary disease in outpatient care; US-focused multisociety guidance for clinicians.

Brief summary of who or what was studied.

Reviewer Notes

Best classified as a clinical practice guideline; no participants or outcomes; recommendations graded by COR/LOE.

Publication Details

DOI

10.1161/cir.0000000000001168

Published

July 20, 2023

Citations

1022 citations

FWCI

343.77

External Resources

DOI Link OpenAlex

Disclaimer: This assessment is generated by AI and should not be the sole basis for clinical or research decisions. Always review the original paper and consult with domain experts.

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