Pam Hollsten, RN, BSN, LNCC
For those readers who are familiar with the 2002 ACC/AHA Guidelines and have practiced in emergency department and coronary care units, the advances and various treatment options available to cardiac patients has continued to expand and be further refined as a result of ongoing clinical trials and publications. It was only a matter of time until an update of the guidelines for patients with unstable angina and non-ST-elevation myocardial infarctions would be published.
These changes flow across all clinical departments to include EMS, triage and ER departments, interventional cardiology, coronary care units as well as medical management prior to and after discharge. It is important to note that these guidelines provide a range of acceptable options based on specific patient characteristics, while acknowledging the limitations and variations in experience, skill and facility capabilities.
Following is a brief summary of those important changes and treatment options that should be reviewed when a case involving cardiac issues comes across your desk. The full text version of this guideline is available at www.acc.org. In contrast to the earlier 2002 version, which promoted early initial invasive strategies for all patients, the revised guidelines now further define low- and high-risk patients, and recommend conservative, non-invasive management for low-risk patients.
• After initial stabilization of the unstable angina and/or non-ST-elevation MI patient, the use of various risk scoring criteria are recommended to further delineate if the patient is an appropriate candidate for invasive or conservative treatment. This represents a significant change in previous options, based on data from several major clinical trials.
• Important recommendations for the global use and duration of antiplatelet therapy for patients, and management of patients with stents of all types, are discussed in detail. The aggressive anticoagulant and preventive strategies also include the recommendation to stop all NSAIDs during hospitalization through discharge.
• Hormone replacement therapy is not recommended for secondary prevention of coronary disease in women.
• Long-term prevention recommendations also reflect more aggressive treatment of lipid and triglyceride disorders, prior to discharge, and initiation of beta blocker and ACE inhibitors in the acute hospitalization phase.
Key references and resources for the treatment of the patient with cardiovascular disease are located athttp://www.cardiosource.com, an on-line resource from the American College of Cardiology Foundation.
Pam Hollsten, RN, BSN, LNCC is a legal nurse consultant with over ten years experience in medical malpractice and catastrophic personal injury cases.
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