Stable Coronary Artery Disease Patients: Different Practice Patterns in Everyday Clinical Situations

http://dx.doi.org/10.1016/j.ebiom.2015.10.007 2352-3964/© 2015 The Author. Published by Elsevier B.V I read with great interest in the article entitled “Practice patterns for physicians to use tests/procedures rather than simply provide clinioutpatients with stable coronary artery disease: a case vignette-based survey among French cardiologists” presented by Christophe Bauters and colleagues in EBioMedicine (Bauters et al., 2015). Authors have assessed the practice patterns for stable coronary artery disease (CAD) outpatients based on an originalmethod of survey among French cardiologists in the Nord-Pas-de-Calais Region (France). As it was underlined by authors of the article background, a number of everyday clinical situations among patients with stable CAD are not specifically covered by current clinical recommendations or the level of obtained evidence is low. Indeed, the lack of tightly adherence and poor perception of specific drugs (βblockers, anticoagulants, antiplatelets, statins, angiotensin-converting enzyme inhibitors and other renin-angiotensin system blockers), as well as avoid of specific diagnostic procedures (exercise tolerance tests, angiography, othermethods of coronary artery visualizations), and possible PCI or coronary artery bypass grafting ion case when clinical decision is not exactly determined by guidelines would probably be associated with poor clinical outcomes or worse of quality of life in the patient population with cardiovascular disease (Murga et al., 2015; Goossens et al., 2015; Rothberg et al., 2015; Sasaki et al., 2014). Authors of the article have investigated responses of cardiologists when stable CAD could be presented. In these cases the decisionmaking based on opinion of cardiologists regarding management of outpatients with stable CAD might be interested to disseminate an experience of cardiologists and induce improving of clinical recommendations in short-term perspective. Authors of the study conducted a cross-sectional survey of cardiologists using the original survey consisted of six questions pertaining to two clinical scenarios regarding decision making in treatment of stable CAD outpatients. The results of the survey provided by authors have shown that academic cardiologists were more likely to adopt new drug approaches, such as direct oral anticoagulants, or newer attitudes such as prescribing anticoagulants alone rather than dual antithrombotic therapy when anticoagulants were needed. Therefore, there was a frequent decision to go directly to coronary angiography in cases of recurrent angina in known CAD patients. It was found that interventional cardiologists were less likely to discontinue β-blockers before prescribing an exercise test. Overall authors believe that the current health system in France encourages