2017, Volume 24, Supplement 1: Optimising the management of post-ACS patients

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....

Click here to take a CPD test on this article Acute coronary syndrome (ACS) accounts for a substantial number of admissions to UK hospitals. As a result of the application of guideline-indicated treatments for acute myocardial infarction, early mortality rates following acute myocardial infarction (AMI) have declined. However, the risk of future fatal and non-fatal cardiovascular events following AMI is high. Women, the elderly and the comorbid are at higher risk of adverse clinical outcomes following AMI and require careful optimisation of treatment. Quality indicators for AMI allow the evaluation of care, and their attainment is negatively associated with mortality. However, scientific advances are also required to enable a greater understanding of the survivorship trajectories of patients with ACS and, therefore, how novel healthcare interventions may maintain healthy longevity. ...

Click here to take a CPD test on this article Dual antiplatelet therapy (DAPT) post-acute coronary syndrome (ACS) is well established. Currently, three oral P2Y12 inhibitors are available in clinical practice with distinct properties for each. The optimal duration of therapy has been the subject of debate over the last decade. Recently, the PEGASUS-TIMI 54 (Prevention of Cardiovascular Events in Patients with Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin-Thrombolysis in Myocardial Infarction 54) trial demonstrated the efficacy of long-term ticagrelor-based DAPT with a trend towards improved cardiovascular mortality. Based on this, the National Institute for Health and Care Excellence (NICE) has endorsed ticagrelor 60 mg as an option for extended DAPT after the first year post-ACS. However, balancing the risks of ischaemic and bleeding events poses a challenge for decision-making. Here, we consider the currently available oral P2Y12 inhibitors, including the evidence for or against long-term DAPT....

Click here to take a CPD test on this article The acute care of patients following myocardial infarction has progressed steadily over the past 29 years to the point that we expect the majority of patients to be discharged relatively unscathed. After discharge the patient still needs care to return to a normal life and to prevent recurrent events. The organisation of aftercare varies, and, in some cases, will not happen. An aftercare strategy that is coordinated between primary care, secondary care and the local providers of rehabilitation is required. Those responsible for commissioning services need to be aware of their responsibilities in this matter. This process might be improved by the provision of a one-year post-event follow-up....