The National Institute for Health and Clinical Excellence is hoping new guidelines on the early management of Acute Coronary Syndromes – specifically unstable angina and a specific type of heart attack called non-ST elevation myocardial infarction (NSTEMI) – will “significantly reduce” the number of related preventable deaths in the UK.
As NICE points out, while huge strides have been made in heart care since the publication of the National Service Framework for Coronary Heart Disease in 2000, over 40,000 patients with NSTEMI acute coronary syndromes alone were admitted to hospital in England and Wales last year. And this, coupled with “worrying increases” in key heart risk factors such as obesity and diabetes, means the management of these conditions is a high priority, it said.
The ACS guideline recommends that aspirin and other blood clot busters are offered to patients as soon as unstable angina or NSTEMI has been diagnosed, and that a formal assessment of the risk of future adverse cardiovascular events is carried out. Following assessment, treatments should be tailored according to the level of the patient’s risk of future events, taking into account the potential for side effects such as bleeding.
The guideline also stresses the importance of making sure patients are well informed about their diagnosis and the subsequent follow-up pathways, and says doctors should dish out advice on cardiac rehabilitation programmes and lifestyle changes, such being physically active, not smoking and eating a Mediterranean-style diet, to help prevent a future cardiovascular event.
According to NICE Deputy Chief Executive Dr Gillian Leng, there is now a much better understanding of which treatments for ACS will benefit which patients, and she said the new guideline “distils all the research conducted in this area into a single, authoritative source that will enable patients to benefit from a coherent and consistent approach to the management of their condition and, we hope, significantly reduce the number of preventable deaths as a result”.
“Cardiovascular diseases still account for more deaths than any other set of conditions in the UK, and are responsible for around 53,000 premature deaths annually,” said RCGP Chairman Prof Steve Field, welcoming the recommendations. “Any guidance that leads to improvements in diagnosis and treatment for patients with these conditions, and as a consequence improves their clinical outcomes will be welcomed by GPs and their teams”.
