Simplified approach to the management of patients with an acute coronary syndrome

A simplified approach to the management of patients with an acute coronary syndrome (chest pain at rest or with mild exertion) can help ensure that precise risk-reducing strategies are followed to the letter by doctors and other caregivers of patients with this medical condition, according to a study by Johns Hopkins researchers.

"Many doctors think existing guidelines are lengthy and complex and therefore difficult to implement in the clinic and at home by patients," says Roger S. Blumenthal, M.D., associate professor of medicine, director of the Ciccarone Preventive Cardiology Center at Johns Hopkins, and senior investigator of the study, published in the Jan. 19 issue of the Journal of the American Medical Association.

The new guidelines are based on those developed by the American College of Cardiology (ACG),the American Heart Association (AHA) and the results of recent clinical trials, and include risk-factor reduction, lifestyle changes and drugs.

To develop the guidelines, the researchers reviewed all of the relevant peer-reviewed medical publications from 1990 to 2004 in order to assess the most effective and safest practices. They conclude that once patients most likely to benefit from either an early invasive or early conservative strategy are identified, a comprehensive management plan following a simple "ABCDE" approach can be applied.

The "alphabet" approach includes "A" for antiplatelet therapy, anticoagulation, angiotensin converting enzyme inhibition, and angiotensin receptor blockade; "B" for beta-blockade and blood pressure control; "C" for cholesterol treatment and cigarette smoking cessation; "D" for diabetes management and diet; and "E" for exercise.

For the study, the researchers focused on one type of coronary artery disease, called non-ct-segment elevation acute coronary syndrome.

According to the AHA, acute coronary syndrome is an umbrella term describing a group of clinical symptoms associated with chest pain (acute myocardial ischemia) caused by insufficient blood supply to the heart muscle because of clogged arteries. Non-st-segment elevation acute coronary syndrome is a very common form of this disease, according to the AHA, and is a major cause of emergency care and hospitalization in the United States.

An estimated 1.6 million Americans suffer from an acute coronary syndrome each year. Blumenthal estimates that less than half of these patients get optimal treatment because of the complexity of monitoring and implementing multidrug and lifestyle treatments.

The study was funded by the Maryland Athletic Club Charitable Foundation in Lutherville, Md. Other authors are Ty Gluckman, M.D., Molly Sachdev, M.D., and Steven Schulman, M.D., all from Johns Hopkins.

On the Web:

http://www.hopkinsmedicine.org/cardiology/faculty.cfm
http://jama.ama-assn.org/