For this question, I will split coronary heart disease patients into two groups.
The first group will be those patients with coronary heart disease but have not had an event yet.
For example, when you come for health screening, then we do some checks like the CT Scan like an Angiography before finding out if you have some coronary artery disease. Essentially, this happens when you've never had an event yet, never had a heart attack, never had a stroke, essentially have no Ischemia event as we call it. If you have no proven Ischemia event but you incidentally found a coronary artery disease, what do you do?
The second category will be known coronary artery disease but you already have had an Ischemia event. That means did you have a stroke before, heart attack before that's why you knew you had a coronary artery disease, that's the second group.
For patients who already had a known event, we do secondary prevention. Secondary prevention patients normally have a stricter follow up. It has to be a closer follow up, maybe once every 3-4 months.
When we do follow-ups for such patients, usually, it's for a few purposes.
First, to evaluate in terms of symptoms whether there is a recurrence of symptoms
Second, side effects of medication
Third, the adjustment of medication.
There is an old medical saying of "Start low go slow" applies to medicine as well also, because, for example for bisoprolol, the maximum dose can go as high as 20mg even.
Usually, patients take 10mg, but on the first dosage, doctors don't give 10mg directly. You usually start at 2.5mg. Then when they come for review, you check and make sure there is no side effects.
Then you start increasing the dosage because, in all the trials conducted for patients, there is a certain dosage that the trials were conducted at.
Fourth, to check for additional cardiovascular risk factors.
So for example, if they had an event and had high blood pressure and cholesterol, then you also check for other risk factors. For example, have they started smoking because of stress, or have they developed diabetes. Then we will manage from there. These are what we call modifiable risk factors.
For this second group of patients, the follow-ups are every 4 months to 6 months. There is no need to be so close. Again, during the purpose of the follow-up is to see if there is any development of symptoms, to see whether there risk factors are well optimized, and to see whether they have developed any new risk factors.
