New Acute Coronary Syndromes Clinical Care Standard

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Acute coronary syndromes (heart attacks and suspected heart attacks) affect thousands of Australians. In 2011, approximately 69,900 Australians aged 25 and over had a heart attack. That’s around 190 hearts attacks a day.¹

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Despite well-developed guidelines for managing acute coronary syndromes, recent research has found that not all patients receive appropriate therapies, particularly for invasive management of this condition.² Research has also highlighted the logistical challenges of providing timely invasive management to patients in regional, remote and outer metropolitan areas.²
The Australian Commission on Safety and Quality in Health Care (the Commission) has developed the Acute Coronary Syndromes (ACS) Clinical Care Standard in collaboration with consumers, clinicians, researchers and health service organisations. The ACS Clinical Care Standard aims to ensure a patient with an acute coronary syndrome receives optimal treatment from the onset of symptoms through to discharge from hospital, regardless of the patient’s location within Australia.
The ACS Clinical Care Standard describes the care a patient with a suspected acute coronary syndrome should be offered from the onset of symptoms to the completion of treatment in hospital. It covers recognition of an acute coronary syndrome, rapid assessment, early management and early initiation of a tailored rehabilitation plan.The ACS Clinical Care Standard complements existing efforts supporting the delivery of appropriate care, such as national initiatives led by the National Heart Foundation, and state and territory-based initiatives led by cardiac networks.
The ACS Clinical Care Standard consists of six quality statements developed for use in hospitals and other healthcare settings:

1. A patient presenting with acute chest pain or other symptoms suggestive of an acute coronary syndrome receives care guided by a documented chest pain assessment pathway.


2. A patient with acute chest pain or other symptoms suggestive of an acute coronary syndrome receives a 12-lead electrocardiogram (ECG) and the results are analysed by a clinician experienced in interpreting an ECG within 10 minutes of the first emergency clinical contact.


3. A patient with an acute ST-segment-elevation myocardial infarction (STEMI), for whom emergency reperfusion is clinically appropriate, is offered timely percutaneous coronary intervention (PCI) or fibrinolysis in accordance with the time frames recommended in the current National Heart Foundation of Australia Cardiac Society of Australia and New Zealand Guidelines for the Management of Acute Coronary Syndromes.³In general, primary PCI is recommended if the time from first medical contact to balloon inflation is anticipated to be less than 90 minutes, otherwise the patient is offered fibrinolysis.


4. A patient with a non-ST-segment-elevation acute coronary syndrome (NSTEACS) is managed based on a documented, evidence-based assessment of their risk of an adverse event.


5. The role of coronary angiography, with a view to timely and appropriate coronary revascularisation, is discussed with a patient with a NSTEACS who is assessed to be at intermediate or high-risk of an adverse cardiac event.


6. Before a patient with an acute coronary syndrome leaves the hospital, they are involved in the development of an individualised care plan. This plan identifies the lifestyle modifications and medicines needed to manage their risk factors, addresses their psychosocial needs and includes a referral to an appropriate cardiac rehabilitation or another secondary prevention program. This plan is provided to the patient and their general practitioner or ongoing clinical provider within 48 hours of discharge.

The Commission has developed a range of resources for clinicians and health service organisations to assist with implementation of the ACS Clinical Care Standard, including tools for local monitoring and evaluation, and fact sheets for clinicians and patients.
The Commission’s Clinical Care Standard program focuses on reducing the gap between what we know works, based on best available evidence, and what care is actually offered to patients
References
1. Australian Institute of Health and Welfare. Australia’s health 2014. Canberra: AIHW, 2014.
2. Chew DP, French J, Briff a TG, Hammett CJ, Ellis CJ, Ranasinghe I, et al. Acute coronary syndrome care across Australia and New Zealand: the SNAPSHOT ACS study. Medical Journal of Australia. 2013;199(3):185–91.
3. Acute Coronary Syndromes Working Group. Guidelines for the management of acute coronary syndromes 2006. Medical Journal of Australia. 2006; 184(8):S1-S30.
For more information, and to download the ACS Clinical Care Standard and resources,
visit www.safetyandquality.gov.au/ccs.