RESUMO
Please note that on p.929 in 5.2.2.7, paragraph 3, the dose of dabigatran should read as BD rather than daily. We regret any inconvenience that this may have caused.
RESUMO
INTRODUCTION: The modern care of suspected and confirmed acute coronary syndrome (ACS) is informed by an extensive and evolving evidence base. This clinical practice guideline focuses on key components of management associated with improved clinical outcomes for patients with chest pain or ACS. These are presented as recommendations that have been graded on both the strength of evidence and the likely absolute benefit versus harm. Additional considerations influencing the delivery of specific therapies and management strategies are presented as practice points. MAIN RECOMMENDATIONS: This guideline provides advice on the standardised assessment and management of patients with suspected ACS, including the implementation of clinical assessment pathways and subsequent functional and anatomical testing. It provides guidance on the: 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; and implementation of an individualised secondary prevention plan that includes both pharmacotherapies and cardiac rehabilitation. Changes in management as a result of the guideline: This guideline has been designed to facilitate the systematic integration of the recommendations into a standardised approach to ACS care, while also allowing for contextual adaptation of the recommendations in response to the individual's needs and preferences. The provision of ACS care should be subject to continuous monitoring, feedback and improvement of quality and patient outcomes.
Assuntos
Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/terapia , Guias de Prática Clínica como Assunto , Síndrome Coronariana Aguda/reabilitação , Angioplastia Coronária com Balão , Anticoagulantes/uso terapêutico , Austrália , Cardiologia/normas , Gerenciamento Clínico , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Nova Zelândia , Inibidores da Agregação Plaquetária/uso terapêutico , Sociedades Médicas/normasRESUMO
BACKGROUND: Research on Australian cardiovascular disease secondary prevention and cardiac rehabilitation to guide practice needs updating to reflect current context of practice. It is timely therefore to review the core components that underpin effective services that deliver maximum benefits for participants. METHODS: The Australian Cardiovascular Health and Rehabilitation Association (ACRA) convened an inter-agency, multidisciplinary, nationally representative expert panel of Australia's leading cardiac rehabilitation clinicians, researchers and health advocates who reviewed the research evidence. RESULTS: Five core components for quality delivery and outcomes of services were identified and are recommended: 1) Equity and access to services, 2) Assessment and short-term monitoring, 3) Recovery and longer term maintenance, 4) Lifestyle/behavioural modification and medication adherence, and 5) Evaluation and quality improvement. CONCLUSIONS: ACRA seeks to provide guidance on the latest evidence in cardiovascular disease secondary prevention and cardiac rehabilitation. Clinicians should use these core components to guide effective service delivery and promote high quality evidence based care. Directors of hospitals and health services should use these core components to aid decision-making about the development and maintenance of these services.