Healio recently interviewed Cedars-Sinai cardiologist Raj Khandwalla, MD, director of Digital Therapeutics at the Smidt Heart Institute, about how primary care physicians can better assess and address their patients' cardiovascular health.

Assessing chest pain and determining whether it could be related to cardiovascular disease can be very challenging for primary care physicians, Khandwalla told Healio. He recommended the 2021 guideline for evaluating and diagnosing chest pain from the American College of Cardiology and the American Heart Association as "a useful tool to guide primary care physicians in determining a pretest probability of the likelihood of a patient having coronary disease."

The guideline helps physicians classify chest pain as cardiac, possibly cardiac or non-cardiac. Chest pain caused by cardiac issues tends to be related to exertion or stress and often feels like pressure, squeezing, heaviness or tightness in the center of the chest, Khandwalla told Healio. In contrast non-cardiac chest pain tends to be sharp, fleeting and related to breathing or position.

Using a tool like the guideline to categorize symptoms "can help primary care physicians assess cardiovascular risk more accurately,” said Khandwalla, who is an assistant professor of Cardiology.

Khandwalla said that many primary care physicians misunderstand the benefits of using a stent—an expandable coil inserted in narrowed or blocked coronary arteries—to treat stable coronary disease. “The perception out there is that if you put a coronary stent in someone with stable chest pain or stable angina, you’re going to prevent heart attacks or prolong people’s life,” Khandwalla told Healio. He said multiple studies have demonstrated that this type of treatment has not been shown to decrease heart attacks, death, and death from a cardiovascular cause.

Rather than recommending stents for patients with stable heart disease, Khandwalla encouraged primary care physicians to monitor their patients’ symptoms and to watch for new chest pain or a decrease in exercise tolerance.

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