International Journal of Cardiovascular Sciences. 17/jan/2025;38:e20240103.

Management of Chronic Coronary Syndromes in Resource-Constrained Settings in India: An Expert Opinion With a Proposed Algorithm

Vijay Shah , Saumitra Ray , Devanu Ghosh Roy , Samir Kubba , Sarita Rao, Jabir Abdullakutty , Kumar K. P. Suresh

DOI: 10.36660/ijcs.20240103

Este Artigo de Revisão é referido pelo Editorial "Recognizing the reality of cardiovascular diseases".

Abstract

Cardiovascular diseases (CVDs) are associated with considerable morbidity and mortality across the world. The global financial burden caused by CVD emphasizes the importance of preventive strategies and appropriate management. Chronic coronary syndrome (CCS) is a new term recently introduced for stable coronary artery disease (CAD), which is associated with the highest cause-specific mortality in the Indian population. CCS adversely affects the quality of life (QoL) due to anxiety, fatigue, and prolonged disease course. Risk factor modification, adaptation to lifestyle changes, and pharmacotherapy are the optimal treatment options for CCS. Despite the guidelines proposed by numerous groups and societies, such as the European Society of Cardiology (ESC), the American College of Cardiology/American Heart Association (ACC/AHA), and the Taiwan Society of Cardiology, managing CCS in resource-limited situations remains challenging. Lack of awareness about CCS among patients and healthcare professionals (HCPs), limited resources, accessibility and affordability of lifesaving therapies, poor transport facilities for patients, and asymmetrical distribution are among the challenges identified. In India, the scenario of CCS is no different in rural areas and among urban poor populations due to resource constraints. The current expert opinion review based on 48 experts in the field of cardiology from eastern, western, northern, southern, and pan-India regions highlights the management of CCS in resource-constrained settings with a focus on diagnostic modalities, risk stratification, referral pathways, and medical management. Based on expert opinions and a thorough literature search, an algorithm for the management of patients with CCS in resource-constrained settings in India is also proposed.