NICE heart guidance set to cut the number of deaths from heart attacks
As soon as patients are diagnosed with an acute coronary syndrome (ACS), a group of heart conditions that includes unstable angina and heart attacks, they should be screened to identify their risk of future heart attacks and offered treatment tailored to their individual needs, according to latest NICE guidance.
The guidance on ACS is published today alongside a separate piece of NICE guidance on the diagnosis of chest pain, and coincides with the tenth year anniversary of the Department of Health's National Service Framework for Coronary Heart Disease.
Nearly 50 per cent fewer people are dying of heart disease since the introduction of the framework in England in March 2000, but an increase in the prevalence of risk factors such as obesity and diabetes means that preventing deaths from heart disease is still a major priority.
Under the ACS guidelines, clinicians should use an established risk scoring system, such as the GRACE score, to predict the 6-month risk of mortality from ACS.
The guidance then recommends treatments that are tailored to the individual needs of the patient, according to whether the patient is high, intermediate or low risk of future adverse cardiovascular events, and help to balance out the benefits of treatment against any possible side-effects such as bleeding.
Dr Huon Gray, consultant cardiologist at Southampton University Hospital and clinical advisor to the Guideline Development Group, said: “The number of treatments that can reduce deaths from unstable angina and heart attacks has increased considerably over the last 20 years.”
But problems with bleeding, and the fact that those at highest risk after their heart attack are often those who also have a high risk of complications, has made it difficult for clinicians to know which treatment is best for individual patients, said Dr Gray.
“This guideline has addressed the assessment of risk in great detail and made clear recommendations regarding the place of drugs, and techniques such as coronary angioplasty and bypass graft surgery.
“I would encourage diagnosis within 96 hours of admission to hospital, and ideally even earlier.”
Dr Gillian Leng, deputy chief executive of NICE and an expert in vascular disease, added: “We now have a much better understanding of what treatments are likely to be of most benefit to which patients.
“This guideline distils all the research conducted in this area into a single, authoritative source that will enable patients to benefit from a coherent and consistent approach to the management of their condition and, we hope, significantly reduce the number of preventable deaths as a result.”
Gavin Maxwell, a patient representative on the Guideline Development Group who suffered a heart attack and now requires ongoing heart monitoring, welcomed the guidance and in particular the recommendation that all patients who suffer an ASC be offered a course of cardiac rehabilitation.
“I have benefited from a programme of rehabilitation which gave me advice on lifestyle, diet, exercise and psychological support which has helped me lead an active life even into my eighties.”
Elsewhere, the NICE guidance on chest pain focuses on making an early diagnosis of chest pain to ensure that patients receive the right treatment and avoid any unnecessary investigations.
The guideline is split into two separate diagnostic pathways, the first for patients with acute chest pain who may have an ACS and the second for those with intermittent stable chest pain who may have stable angina.
Professor Liam Smeeth, a GP in London and a member of the chest pain Guideline Development Group, said: “An early diagnosis is important because the earlier you can get a clear diagnosis for the patient, the fewer tests they will have to have and the sooner they can be offered treatment. One of the worries for GPs is that patients often have to have to go for test after test, each of which is never quite conclusive.”
The guidance also represents a significant change in practice in some key areas of diagnosing an ACS and angina.
“One of the key changes in this guidance is that in no patient without established cardiovascular disease is exercise ECG the best initial diagnostic strategy, and that is quite counter to what is currently done and will be quite a big change in clinical practice,” warned Professor Smeeth
24 March 2010
This page was last updated: 30 March 2010