As a clinician, evidence based practice is fundamental in deploying care that is proven through scientific and clinical data. Clinical practice guidelines (CPG) are established on this foundation and take considerable time and effort to identify specific diagnostic and therapeutic tools that help improve health outcomes. However, CPG's are only updated and published every 4-6 years depending on the disease area. This is a cause to pause, because significant and emerging data may be available that should qualify a clinical tool for consideration as a recommended guideline. For example, the current ACC/AHA guidelines around the management of non-ST elevation ACS (NSTE-ACS) was published in 2014, a time when there were no high sensitivity cardiac troponin assays cleared by the FDA for use in the US. Meanwhile, since its publication, the 4th Universal Definition of MI was published which is driven by changes in the serial measurement of cardiac troponin by high sensitivity assays (hs-cTn), a pivotal progression not reflected in the ACC/AHA guidelines. As a matter of course, societies like the American College of Emergency Physicians (ACEP) has developed clinical policies in advance of the next guideline publication to address the ascendency of hs-cTn testing.
Similar to the management of NSTE-ACS, the management of patients with CHD and the assessment of risk in individuals for developing CHD is challenging. And despite the strides that have been made in improving outcomes, the prevalence and burden of CHD continue to rise.