Preface

"Medical practitioners should regard this guideline as a useful reference tool: not the rulings of philosopher kings, but the attempt of thoughtful people to share their knowledge - albeit imperfect - with other people."

Adapted from Tong, R. (1991) The epistemology and ethics of consensus: uses and misuses of "ethical" expertise Journal of Medicine and Philosophy 16: 409-426.

Martin Eccles

Acknowledgements

Contents

• Summary
• Methods
  • Aim of the guideline
  • Responsibility and support for guideline development
  • Guideline development group
  • Evidence identification and synthesis
  • External review of the guideline
  • Piloting/pre-testing of the guideline
  • Scheduled review of the guideline
• Introduction - Epidemiology of coronary heart disease
• Guideline
  • Scope of the guideline
  • Initial assessment
  • Age limits
  • Precipitating factors
  • Investigation of angina
    • Resting 12 lead ECG
    • Exercise testing
  • Management of risk factors
    • Cholesterol
    • Blood pressure
    • Smoking cessation
    • Exercise
    • Weight reduction
  • Occupation
  • Driving
  • Drug treatment
    • Secondary prophylactic treatment
    • Initial symptomatic treatment
    • Regular symptomatic treatment
    • Monotherapy
    • Choosing a beta-blocker
    • Substitution monotherapy in patients intolerant of beta-blockers
    • Choosing a second drug
    • Choosing a third drug
  • Referral
    • Referral for exercise testing
    • Referral to a cardiologist
  • Appendix 1: Cardiac fitness for vocational driving
  • Appendix 2: MEDLINE search strategy
  • Appendix 3: Criteria against which the literature were
  • assessed
  • Appendix 4: Instructions for reviewers