title: Practice Patterns for Outpatients With Stable Coronary Artery Disease: A Case Vignette-based Survey Among French Cardiologists.
abstract: BACKGROUND
  Although medical management of patients with coronary artery disease (CAD) is often based on scientific guidelines, a number of everyday clinical situations are not specifically covered by recommendations or the level of evidence is low. The aim of this study was to assess practice patterns regarding routine management of patients with stable CAD.
  
  
  METHODS
  A survey comprising six questions on two clinical scenarios regarding stable CAD management was sent to 345 cardiologists from the Nord-Pas-de-Calais Region (France). We first assessed practice patterns globally and then searched for associations with physician characteristics (age, gender, sub-specialty, and type of practice).
  
  
  RESULTS
  The response rate was 92%. Regarding management of asymptomatic CAD, 86% of the cardiologists performed routine exercise testing, before which, 69% withdrew β-blockers. After a positive exercise test, 26% immediately performed coronary angiography and 67%, further imaging tests. In the absence of left ventricular dysfunction or history of myocardial infarction, routine β-blocker prescription for stable CAD was selected by 43%. When anticoagulation was needed for atrial fibrillation, 41% initiated direct oral anticoagulants rather than vitamin-K antagonists and 50% combined aspirin with anticoagulants. For recurrent stable angina in patients with known CAD, 24% performed coronary angiography directly, 49% requested a stress test, and 27% opted for medical therapy without further diagnostic testing. Age, gender of the cardiologist, academic environment, and practice of interventional cardiology were associated with certain management patterns.
  
  
  CONCLUSIONS
  When not guided by high-level recommendations, practice patterns for routine clinical situations in stable CAD vary considerably. Future clinical trials should address these clinical interrogations.
authors: Centre Hospitalier Régional et Universitaire de Lille, Lille, France; Inserm U1167, Institut Pasteur de Lille, Université Lille Nord de France, Lille, France; Faculté de Médecine de Lille, Lille, France.
authors: Christophe
authors: C
authors: Bauters
authors: Centre Hospitalier Régional et Universitaire de Lille, Lille, France; Inserm U1167, Institut Pasteur de Lille, Université Lille Nord de France, Lille, France; Faculté de Médecine de Lille, Lille, France.
authors: Gilles
authors: G
authors: Lemesle
authors: Centre Hospitalier Régional et Universitaire de Lille, Lille, France; Inserm U1167, Institut Pasteur de Lille, Université Lille Nord de France, Lille, France; Faculté de Médecine de Lille, Lille, France.
authors: Nicolas
authors: N
authors: Lamblin
authors: Department of Cardiology, Hôpital Européen Georges Pompidou, Assistance Publique des Hôpitaux de Paris, Paris, France; Université Paris Descartes, Paris, France.
authors: Nicolas
authors: N
authors: Danchin
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000592:standards; D002309:Cardiology; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D003430:Cross-Sectional Studies; D019468:Disease Management; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D010820:Physicians; D010818:Practice Patterns, Physicians'; D011795:Surveys and Questionnaires
keywords: Angina; Anticoagulation; Beta-blockers; Coronary Angiography; Coronary Artery Disease; Exercise Testing