*Lost future earnings of persons who will die in 2010, discounted at 3%. Reproduced from Lloyd-Jones et al.27 Figure 2. Diagnosis of patients with suspected ischemic heart disease.* *Colors correspond to the class of recommendations in the ACCF/AHA Table 1. The algorithms do not represent a comprehensive list of recommendations (see text for all recommendations). See Table 2 for short-term risk of death or nonfatal MI in patients with UA/NSTEMI. CCTA is reasonable only for patients with inter- mediate probability of IHD. CCTA indicates computed coronary tomography angiography; CMR, cardiac magnetic resonance; ECG, electrocardiogram; Echo, echocardiography; IHD, ischemic heart disease; MI, myocardial infarction; MPI, myocardial perfusion imaging; Pharm, pharmacological; UA, unstable angina; and UA/NSTEMI, unstable angina/non ST-elevation myocardial infarction. Fihn et al Stable Ischemic Heart Disease: Full Text e365 informed decision, it is essential to elicit the breadth of their knowledge, values, preferences, and concerns. The healthcare provider has a responsibility to ensure that patients understand and consider both the upside and down- side of available options, in both the near and long terms. All previous guidelines reviewed by the writing committee have recognized the crucial role that patient preferences play in the selection of a treatment strategy.9,10,47 49 It is essential that these discussions be conducted in a location and atmosphere that permits adequate time for discussion and contemplation. Initiating a discussion about the relative merits of PCI or CABG while a patient is in the midst of a procedure, for example, is not usually consistent with these principles. In crafting a diagnostic strategy, the objective is to ascer- tain, as accurately as possible, whether the patient has IHD while minimizing the expense, discomfort, and potential harms of any tests or procedures. 