MedicationsLIVEBETTER: A Trial Comparing Medications in Older Adults With Stable Angina and Multiple Chronic Conditions

Inclusion Criteria:

OLDER ADULTS WITH SIHD AND MCC

• Age ≥65 years
• ≥ 2 Multiple Chronic Conditions as defined by Centers for Medicare and Medicaid Services (CMS)
• Diagnosis of Symptomatic Stable Ischemic Heart Disease with plans to initiate medical therapy identified by at least one of the following:

1. positive non-invasive functional or anatomic testing suggestive of obstructive coronary artery disease
2. coronary angiography with stenosis ≥70% in a coronary artery ≥2 mm in diameter or

≥50% stenosis of left main
3. Invasive coronary angiography with positive physiologic testing in at least one vessel (FFR ≤ 0.80 or iFR ≤0.89)

CAREGIVERS

• Age ≥ 18 years
• Identified as caregiver of LIVEBETTER participant

Exclusion Criteria:

OLDER ADULTS WITH SIHD AND MCC

• Current taking (both) a beta-blocker AND a calcium channel blocker\*
• Contraindication to beta-blockers or calcium channel blockers including:

1. significant hypotension
2. high grade AV block
3. severe symptomatic bradycardia
4. severe obstructive lung disease

• Documented intolerance to beta-blockers or calcium channel blockers
• Probable or definite high-risk coronary artery disease including unrevascularized left main disease and/or unrevascularized multi-vessel disease including the proximal left anterior descending (LAD) artery with plans for immediate complete revascularization
• Plans for complete revascularization within 2 weeks
• Clear clinical indication for beta-blockers or calcium channel blockers that precludes dose adjustment or crossover:

1. Diagnosis of acute coronary syndrome (ACS) with reduced ejection fraction within past year
2. Heart failure with reduced ejection fraction (HFrEF) within past year

• Actively participating in another clinical trial involving an investigational medication or device
• Primary language other than English or Spanish
• Inability to complete follow-up (e.g. life expectancy <12 months, impaired decision-making determined by validated instrument)
• Previously enrolled in LIVEBETTER
• Refused informed consent

CAREGIVERS

• Professional caregiver (i.e. not a relative or close friend of the participant)
• Primary language other than English or Spanish
• Inability to complete follow-up
• Previously enrolled in LIVEBETTER
• Refused informed consent