Cardiologists’ Diagnostic and Therapeutic Approaches in the Outpatient Management of Patients with Chronic Coronary Syndrome in Turkey: An Observational–Registration Study

Abstract

Background: Chronic coronary syndrome (CCS) remains a major cause of morbidity and mortality worldwide, and real-world data on outpatient management are limited. Methods: In total, 697 patients with previously diagnosed CCS who visited outpatient cardiology clinics at 25 centers in Turkey between June 2023 and December 2023 were prospectively enrolled and followed up for 12 weeks. Demographic and clinical characteristics, diagnostic and therapeutic strategies, a modified questionnaire derived from the Seattle Angina Questionnaire (modified SAQ-based questionnaire), and clinical outcomes were recorded. Results: The most common diagnostic modalities were exercise stress testing (31.6%) and coronary angiography (38.2%). Medical therapy (58.5%) was preferred over interventional treatment (41.5%). Among patients who were not receiving the respective medication at baseline, beta-blockers (61.8%), statins (46.5%), and ranolazine (40.4%) were the most commonly newly initiated medications. Patients in the intervention group were younger, were more frequently current smokers, had greater nitrate use, and had lower ejection fraction than those in the medical treatment group. Patient-reported responses to the modified SAQ-based questionnaire shifted toward less functional limitation, lower angina burden, and better perceived quality of life over the 12-week follow-up. Conclusions: Medical therapy was the predominant management strategy for CCS in Turkey. The observed diagnostic and therapeutic patterns reflect real-world management of patients with established CCS, with substantial use of invasive coronary angiography and high baseline utilization of guideline-directed medical therapies.