Thus, follow-up assessment and testing will vary according to the clinical status of the patient and with the evolution of evidence-based practice. Unnecessary testing should be avoided. For patients with SIHD who show no change in symptoms or functional capacity, periodic follow-up serves multiple purposes: Ongoing reassessment of adherence to and effectiveness of the therapeutic regimen, including clinical response, occur- rence of adverse effects, and treatment goals, on the basis of evolving scientific evidence and preferences of the patient. Evaluation of the effectiveness of interventions to modify risk factors such as exertional hypertension. Assessment of the status of coexisting chronic medical conditions that could directly or indirectly affect the management of stable cardiac ischemia. Patients with SIHD who have accelerating symptoms or decreasing functional capacity require prompt reassessment. Patients with SIHD who develop new ACS should be evaluated and treated according to established guidelines.3,4,4a,9,10 Patients who have been treated for an ACS (ie, AMI or UA) within the previous 6 months and who develop chest pain within 30 days of the AMI should be evaluated according to the STEMI or UA/NSTEMI guide- lines as warranted.2 4,4a Patients who have undergone revas- cularization with either PCI or CABG within 6 months should be monitored according to the PCI and CABG guidelines.9,10 Patients with SIHD should be evaluated before elective or emergent surgery according to established perioperative 6.1. Clinical Evaluation, Echocardiography During Routine, Periodic Follow-Up: Recommendations Class I 1. Patients with SIHD should receive periodic follow- up, at least annually, that includes all of the follow- ing (Level of Evidence: C): a. Assessment of symptoms and clinical function; b. Surveillance for complications of SIHD, including heart failure and arrhythmias; c. Monitoring of cardiac risk factors; and d. Assessment of the adequacy of and adherence to recommended lifestyle changes and medical therapy. 2. 