Ischaemic Heart Disease G006

Current RMA Instruments

Changes from previous Instruments

ICD Coding

• ICD-10-AM Code: In the range I20 to I25

Brief description

Ischaemic heart disease is a condition caused by reduced and inadequate blood supply to part of the heart, resulting in infarction (death of heart tissue) or periodic ischaemia (temporary oxygen deprivation to the heart tissue). This occurs due to narrowing, thrombosis, vasospasm or dissection in the coronary arteries. The impairment can present clinically as angina, a myocardial infarct or sudden cardiac death.

Coronary atherosclerosis that has not resulted in ischaemia- angina, infarction or some other cardiac dysfunction, is not covered by this SoP.

Confirming the diagnosis

Establishing the diagnosis involves a thorough clinical assessment, including evaluation of cardiovascular risk factors, along with targeted cardiac investigations. These may include electrocardiograms (ECGs), blood tests (e.g. cardiac enzymes), and cardiac imaging such as echocardiography, nuclear stress testing, CT coronary angiography, and/or coronary angiography (cardiac catheterisation).   

This diagnosis can typically be confirmed by General Practitioners, supported by clinical evidence of cardiac ischaemia. However, the assessment and ongoing management of the condition can often require input from a cardiologist, and any further clarifications may be sought through cardiology consultation. 

Additional diagnoses covered by SOP

• Acute coronary syndrome (including STEMI, NSTEMI, and unstable angina) 
• Angina pectoris (including unstable angina and Prinzmetal angina) 
• Myocardial infarction (ST elevation infarction- STEMI)
• Myocardial ischaemia
• Ischaemia due to coronary artery dissection
• Ischaemic cardiomyopathy

Conditions not covered by SOP

• Coronary atherosclerosis, coronary atheroma, or coronary artery disease without ischaemia- e.g. coronary atherosclerosis found on investigation but there is no evidence of angina or infarction etc. #
• Myocardial infarction due to generalised hypoxia (e.g. severe anaemia, respiratory failure etc), vascular shock or cardiac arrest #

* another SOP applies

# non-SOP condition

Clinical onset

The clinical onset of ischaemic heart disease (IHD) is defined as either the first occurrence of symptoms subsequently confirmed to be attributable to IHD, or the initial detection of cardiac dysfunction due to IHD through investigation.  The incidental finding of asymptomatic coronary atherosclerosis (e.g. on CT scan or angiography) does not constitute a clinical onset of IHD.

Clinical worsening

Most factors that contribute to the clinical onset of IHD- such as developing hypertension, hyperlipidaemia, smoking, diabetes and physical inactivity- can also contribute to its clinical progression or worsening. In addition, the course of IHD can be significantly influenced by timely and appropriate medical management. An inability to access or adhere to effective treatment, including medications, lifestyle interventions, or revascularisations procedures, may result in a sustained or permanent deterioration in cardiac function and overall prognosis.