Optimising Appropriate Medical Therapies may Reduce Acute Coronary Syndromes

To decrease overall mortality due to acute coronary syndromes, we need to focus on optimising appropriate medical therapies, according to an editorial published in the latest issue of Medical Journal of Australia.

Acute coronary syndrome (ACS) is chest pain and other symptoms that happen when blood flow to the heart muscle is suddenly decreased.

Dr Ian Scott, from the Department of Internal Medicine and Clinical Epidemiology at the Princess Alexandra Hospital in Brisbane, says increasing attention is being given to assessing and improving the quality of care for patients presenting with ACS.

Commenting on a research paper that is also in the latest issue of Medical Journal of Australia, Dr Scott said “routine use of more costly invasive care is not associated with population survival benefit beyond that seen with optimal medical management”.

“If decreasing overall 12-month mortality of patients with ACS is the aim, maximising administration of medical therapies with proven benefit among all patients should take precedence over subjecting more patients to invasive management who may not benefit from such care on the basis of randomised trials,” he said.

In the research paper, Dr Derek Chew, a Professor of Cardiology at Flinders University, and his co-authors described the impact of invasive management on 12-month survival among nearly 3,402 patients presenting to 39 Australian hospitals with suspected ACS from November 2005 to July 2007.

Prof Chew and his colleagues looked at the number of patients who had died, suffered myocardial infarction and recurrent myocardial infarction (heart attacks), undergone revascularisation (restoring blood flow to the heart muscle) or had a stroke at 12-months.

“A substantial burden of late morbidity and mortality persists among patients with ACS within contemporary Australian clinical practice,” he said.

The results showed that early invasive management was more commonly undertaken in patients with ST-segment-elevation myocardial infarction (STEMI).

Overall mortality by 12 months was 8.0% for patients with STEMI, 10.5% for those with non-STEMI, 3.3% for those with unstable angina and 3.7% for those with stable angina.

“Under use of invasive management may be associated with an excess in 12-month mortality – suggesting the need for more use of invasive management among these patients,” he said.

The Medical Journal of Australia is a publication of the Australian Medical Association.

Source-MJA
SPH