Guidelines on the management of non-ST elevation acute coronary syndromes

Sep 3 2007

New guidelines for the management of non-ST segment elevation acute coronary syndromes (NSTE-ACS) were released by the European Society of Cardiology in June 2007 replacing previous guidelines of 2002.

The new guidelines include all recent changes in the management of this syndrome, highlighting especially novel drugs that have recently become available in this indication. All very recent information from the latest randomised trials has been evaluated and incorporated in the recommendations.

The guidelines were researched and written by the ESC Task Force on NSTE-ACS, and were co-chaired by Prof. Jean-Pierre Bassand, Past-President of the European Society of Cardiology, and Chief of the Cardiology Department in Besançon, France; and Prof. Christian Hamm, Medical Director of the Kerckhoff Heart Center in Bad Nauheim, Germany.

These guidelines propose a comprehensive, practical strategies for the management of NSTE-ACS, covering diagnostic procedures (especially use of biomarkers), the optimal pharmacological environment, with respect to all the new drugs available, and indications for invasive evaluation and revascularisation strategies.

The novelty of these new guidelines is that they cover some special conditions that have been underestimated or ignored in the past by previous guidelines, but which are the most common problems encountered in daily routine practice. In particular, specific sections are dedicated to special populations such as the elderly, women, chronic renal failure, diabetes, or anemia; and to the management of bleeding complications.

Succinct summaries of the main recommendations make these guidelines easy to read and suitable for daily routine. The optimal management strategy is summarized in a special chapter which allows to translate the recommendations into a concept for daily routine. New is the option to take high-risk patients in a critical condition immediately to invasive evaluation before biochemical tests are available. This brings the physician´s experience back into to the decision process.

Also included is a chapter about performance measures, a new concept whose importance has become increasingly clear during the past few years. The huge number of clinical practice guidelines available in the literature, and the increasing number of organisations and societies producing them, makes it difficult for many clinicians to stay abreast of the latest and most reliable information. Many guidelines exist, without ever being taken up into clinical practice simply because the physicians who are the target audience do not know that guidelines exist. The resulting variations in clinical practice can have repercussions on patients’ outcomes. Regular monitoring of performance indicators can help to increase uptake into clinical practice, thereby improving outcomes.

It is anticipated that the new ESC guidelines on the diagnosis and management of non-ST segment elevation acute coronary syndromes will become the reference for clinicians across Europe and further afield.

Notes

This was presented at the ESC Congress 2007 in Vienna.

The European Society of Cardiology (ESC)

The ESC represents nearly 53,000 cardiology professionals across Europe and the Mediterranean. Its mission is to reduce the burden of cardiovascular disease in Europe.

The ESC achieves this through a variety of scientific and educational activities including the coordination of: clinical practice guidelines, education courses and initiatives, pan-European surveys on specific disease areas and the ESC Annual Congress, the largest medical meeting in Europe. The ESC also works closely with the European Commission and WHO to improve health policy in the EU.

http://www.escardio.org