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Unstable angina and NSTEMI: early management [CG94]

Measuring the use of this guidance

Recommendation: 1.2.2

Include in the formal risk assessment: -a full clinical history (including age, previous myocardial infarction [MI] and previous percutaneous coronary intervention [PCI] or coronary artery bypass grafting [CABG]) -a physical examination (including measurement of blood pressure and heart rate) -resting 12-lead electrocardiography (ECG) (looking particularly for dynamic or unstable patterns that indicate myocardial ischaemia)

What was measured: The number of NSTEMI patients that received an ECG.
Data collection end: June 2013
94.1%
Number that met the criteria: 336094 / 357228
Area covered: England
Source: Dondo TB, Norman P, Dondo TB, et al. (2016) Geographic variation in the treatment of non-ST-segment myocardial infarction in the English National Health Service: a cohort study BMJ Open 6 (7) : e011600-


Recommendation: 1.5.1

Offer coronary angiography (with follow-on PCI if indicated) within 96 hours of first admission to hospital to patients who have an intermediate or higher risk of adverse cardiovascular events (predicted 6-month mortality above 3.0%) if they have no contraindications to angiography (such as active bleeding or comorbidity). Perform angiography as soon as possible for patients who are clinically unstable or at high ischaemic risk.

What was measured: Proportion of patients admitted with NSTEMI who received an angiogram, with or without PCI, within 96 hours.
Data collection end: October 2012
67%
Number that met the criteria: 59 / 88
Area covered: Local
Source: Wang S et al. (2013) Management of NSTEMI with early coronary angiography in accordance with NICE guidelines 2010: A District General Hospital re-audit. European Heart Journal: Acute Cardiovascular Care Conference: June


Recommendation: 1.5.12

All patients who smoke should be advised to quit and be offered support and advice, and referral to an intensive support service (for example, the NHS Stop Smoking Services) in line with 'Brief interventions and referral for smoking cessation in primary care and other settings' (NICE public health guidance 1). (This recommendation is adapted from 'MI – secondary prevention', NICE clinical guideline 172.)

What was measured: The number of NSTEMI patients that received an ECG.
Data collection end: June 2013
12.5%
Number that met the criteria: 31683 / 254215
Area covered: England
Source: Dondo TB, Norman P, Dondo TB, et al. (2016) Geographic variation in the treatment of non-ST-segment myocardial infarction in the English National Health Service: a cohort study BMJ Open 6 (7) : e011600-



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