In this supplement we bring together four highly respected cardiology authors who provide an up-to-date analysis of the current management of the post-acute coronary syndrome (ACS) patient. I have added some thoughts on the care of these patients from a primary care aspect.
We have a wealth of data from two national audits, MINAP (Myocardial Ischaemia National Audit Project) and NACR (National Audit of Cardiac Rehabilitation), as well as registries such as GRACE (Global Registry of Acute Coronary Events). These, together with numerous other data sources, reveal a national picture of a major reduction in the incidence of myocardial infarctions (MIs). Furthermore, while these events do still occur, these data indicate that we are increasingly successful in managing the acute event.
This success has led to new considerations, which the authors will explain. One such consideration is the emerging concept of the very high-risk patient. These are people with multiple events, cardiovascular disease in multiple sites and/or comorbidities. Another way of looking at this is to consider the increasing numbers of survivors. Our success in managing cardiovascular disease is creating a new population of patients to care for.
In healthcare there is seldom a situation where you can say ‘job done’. In the world of infection control, no sooner did we eradicate small pox than other challenges, such as HIV and ebola, appear. In the cardiovascular world we must now concentrate on our survivors.
In terms of the ‘job not done’, we have Chris Gale who will point out that we still have more than 80,000 hospitalisations in the UK for MI every year, many of whom still present late due to a lack of insight into their situation. Wael Sumaya and Rob Storey will explain where we are with antiplatelet medications, an aspect of therapy that is still confusing for many practitioners. Joe Mills and I tackle the complexities of discharge and aftercare with reference to what is and what is not working. We make a suggestion that there may be an alternative to the current strategy, a first anniversary assessment.
You should find interesting facts and concepts throughout this supplement.