More than one half of direct costs are related to hospitalization. In 2003, the Medicare program alone paid $12.2 billion for hospitalizations for IHD, includ- ing $12 321 per discharge for AMI and $11 783 per discharge for admissions for coronary atherosclerosis.39 Another major expense is for invasive procedures and related costs. In 2006 in the United States, there were 1 313 000 inpatient PCI procedures, 448 000 inpatient coronary artery bypass procedures, and 1 115 000 inpatient diagnostic cardiac catheterizations.27,40 In addition, $13 million outpa- tient visits for IHD occur in the United States annually.41 It was estimated that the costs of outpatient and emergency department visits in 2000 by patients with chronic angina were $922 million and $286 million, respectively, and pre- scriptions accounted for $291 million. Long-term care costs including skilled nursing, home health, and hospice care were $2.6 billion, which represented 30% of the total cost of care for chronic angina.42 Although the direct costs associated with SIHD are sub- stantial, they do not account for the significant indirect costs of lost workdays, reduced productivity, long-term medica- tion, and associated effects. The indirect costs have been estimated to be almost as great as the direct costs27,43 (Table 4). The magnitude of the problem can be summarized succinctly: SIHD affects many millions of Americans, with associated annual costs that are measured in tens of billions of dollars. 1.7. Organization of the Guideline The overarching framework adopted in constructing this guideline reflects the complementary goals of treating pa- tients with known SIHD, alleviating or improving symptoms, and prolonging life. This guideline is divided into 4 basic sections summarizing the approaches to diagnosis, risk as- sessment, treatment, and follow-up. 