Updated guidelines for treating heart attack symptoms

Across Australia and New Zealand, mortality and morbidity rates remain significant among patients presenting with acute coronary syndromes (ACS).

While there have been major advances in many areas of heart disease treatment, the SNAPSHOT ACS study reported 18-month mortality rates of 6.8% for those with unstable angina and in excess of 16% for patients presenting with ST-elevation myocardial infarction and non-ST-elevation myocardial infarction.

In response to these figures, the National Heart Foundation (NHF) and the Cardiac Society of Australia and New Zealand (CSANZ) have updated the guidelines for treating ACS with a simplified set of instructions for doctors and a renewed call for greater access to electrocardiogram machines.

The importance of public awareness of heart attack symptoms is also a key area of focus, especially as the broad nature of heart health issues covered by ACS can be confusing for the general public.

Published in the Medical Journal of Australia (MJA), the updated coronary syndrome guidelines were developed by an esteemed team of industry professionals across Australia, led by Professor Derek Chew.

The updated guidelines present a simplified approach for doctors with standardised assessment and management tools regarding suspected cases of ACS. These include:

• diagnosis and risk stratification of ACS;
• provision of acute reperfusion therapy and immediate post-fibrinolysis care for patients with ST-segment elevation myocardial infarction;
• risk stratification informing the use of routine versus selective invasive management for patients with non-ST segment elevation ACS;
• administration of antithrombotic therapies in the acute setting and considerations affecting their long-term use;
• implementation of an individualised secondary prevention plan that includes both pharmacotherapies and cardiac rehabilitation.

The NHF and CSANZ believe that this simplified, standardised approach will help ensure that all patients will receive the same standard of care, regardless of where they live. According to Associate Professor Andrew MacIsaac from St Vincent’s Hospital Melbourne, the new guidelines will “simplify the target time for myocardial reperfusion in patients presenting with an ST-elevation myocardial infarction”.

He would like to see registries of patient outcomes to enhance quality assurance and reiterated the importance of public education regarding heart attack symptoms and the installation of electrocardiogram machines in all ambulances to reduce treatment delays.

“Sustainable funding models need to be established to support the collection of risk-adjusted patient, procedural and device outcomes,” Associate Professor MacIsaac said. “It is incumbent on the cardiac community to ensure that systems, procedures and policies are developed to further reduce the toll of cardiovascular disease in an environment where outcomes are monitored and continuously assessed.”