From the Guidelines
Consulting a cardiologist is a crucial step in managing heart-related symptoms or concerns, as they play a key role in advising on preventive medication and difficult preventive options. During a cardiology consultation, the specialist will typically review your medical history, perform a physical examination, and may order diagnostic tests such as an electrocardiogram (ECG), echocardiogram, stress test, or blood work 1. The cardiologist will assess for conditions like coronary artery disease, heart failure, arrhythmias, valve disorders, or hypertension.
Some key aspects of a cardiologist's role include:
- Coronary angiography (invasive or by CT)
- Functional testing with myocardial perfusion imaging
- Optimisation of pharmacotherapy
- Coronary revascularisation
- Advice on perioperative cardiac management in patients accepted for certain procedures 1. Cardiopulmonary exercise (CPX) testing is also a valuable tool in predicting survival and operative risk, particularly in patients undergoing certain procedures, with a threshold level of <60% peak oxygen consumption during CPX independently predicting survival and length of hospital stay 1.
Following the consultation, the cardiologist may prescribe medications or recommend lifestyle modifications, and it's essential to follow up as directed, typically within 1-3 months for medication adjustments or to review test results. The cardiologist's expertise is vital in preventing serious complications like heart attacks or strokes through timely intervention and appropriate treatment plans.
From the Research
Cardiology Consultation
- When consulting a cardiologist, it is essential to understand the recommendations provided by the physician and the basis for these recommendations.
- According to 2, a physician's decision to offer clinical recommendations contrary to current practice guidelines raises ethical issues, and it is crucial for the physician to communicate the rationale for deviating from clinical guidelines and respect the patient's autonomy.
Clinical Guidelines and Recommendations
- Clinical guidelines should be based on a thorough evaluation of the evidence and include a rating of the quality of evidence and assign a strength to recommendations 3.
- The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach provides guidance on making strong recommendations when the certainty of the evidence is low or very low 3.
- A proposed framework for reducing bias and improving the quality of medical decisions suggests that physicians should reach a clinical recommendation based on medical evidence and patients' values and preferences 4.
Evidence-Based Medicine
- Evidence-based medicine and shared decision making are intended to improve medical decision making, but there has been limited attention to how a recommendation is discretely formulated from these processes 4.
- To justify clinical guideline recommendations comprehensibly, it is essential to present the quality of the published evidence concerning its certainty and patient relevance, as well as additional reasons for the grade of recommendation 5.
Interpreting Clinical Practice Guidelines
- Clinicians must understand the implications of the recommendations, assess the trustworthiness of the development process, and evaluate the extent to which the recommendations are applicable to patients in their practice settings 6.
- Helpful recommendations are clear and actionable, and explicitly specify whether they are strong or weak, are appropriate for all patients, or depend on individual patients' circumstances and values 6.