Find out why the ISCHEMIA trial has big implications for primary care

In this expert interview, Dr Stephen Dorman explains the impact of this groundbreaking trial which looked at whether there is a benefit from invasive procedures over optimal medical therapy in stable patients with moderate to severe ischaemia.

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2 Comments

Go to the profile of Rebecca A Wheater
Rebecca A Wheater about 1 month ago

A helpful overview of the Ischemia Trial. Under current Covid restrictions we are not able to send patients for ETT in my area, where the system set up does not have capacity for many CT-angiograms; thus we have reverted to medicine that we practised 20 years ago & if history suggests angina we are (at the request of our cardiology colleagues) initiating & optimising medical treatment in Primary Care. Naturally this applies to stable angina, with those exhibiting unstable angina being seen by cardiology. You make a great point about LAD disease +/- LVF doing better with intervention. Ischemia was a worthwhile trial in our current medico-economic climate.

thanks.

Rebecca Wheater, GP & Co-Chair of SHARP, Tayside

Go to the profile of Stephen Dorman
Stephen Dorman about 1 month ago

Thanks Rebecca - You are quite correct that most hospitals are very unkeen on doing treadmill tests currently due to the Covid situation and CT capacity is better in some areas than others.   The main value of the CT Coronary angiogram is to quantify the extent of disease and exclude LMS disease. If you can't access the right tests then initiating & optimising medical therapy is a very reasonable and pragmatic response.  I think we have come full circle from highly sophisticated ischaemia testing to going back to ask the patient about their symptom burden.  A high symptom burden is actually a pretty good guide to the need for intervention. 

thanks

Steve Dorman