A simplified approach to the management of patients
with an acute coronary syndrome (chest pain at rest or with
mild exertion) can help ensure that precise risk-reducing
strategies are followed to the letter by doctors and other
caregivers of patients with this medical condition,
according to a study by Johns Hopkins researchers.
"Many doctors think existing guidelines are lengthy
and complex and therefore difficult to implement in the
clinic and at home by patients," said Roger S. Blumenthal,
associate professor of medicine and director of the
Ciccarone Preventive Cardiology Center at Johns Hopkins,
and senior investigator of the study, published in the Jan.
19 issue of the Journal of the American Medical
Association.
The new guidelines are based on those developed by the
American College of Cardiology and the American Heart
Association and the results of recent clinical trials, and
include risk-factor reduction, lifestyle changes and
drugs.
To develop the guidelines, the researchers reviewed
all the relevant peer-reviewed medical publications from
1990 to 2004 in order to assess the most effective and
safest practices. They conclude that once patients most
likely to benefit from either an early invasive or early
conservative strategy are identified, a comprehensive
management plan following a simple "ABCDE" approach can be
applied.
The "alphabet" approach includes "A" for antiplatelet
therapy, anticoagulation, angiotensin converting enzyme
inhibition and angiotensin receptor blockade; "B" for
beta-blockade and blood pressure control; "C" for
cholesterol treatment and cigarette smoking cessation; "D"
for diabetes management and diet; and "E" for exercise.
For the study, the researchers focused on one type of
coronary artery disease, called non-ct-segment elevation
acute coronary syndrome. According to the American Heart
Association, acute coronary syndrome is an umbrella term
describing a group of clinical symptoms associated with
chest pain (acute myocardial ischemia) caused by
insufficient blood supply to the heart muscle because of
clogged arteries. Non-ct-segment elevation acute coronary
syndrome is a very common form of this disease, according
to the AHA, and is a major cause of emergency care and
hospitalization in the United States.
An estimated 1.6 million Americans suffer from an
acute coronary syndrome each year. Blumenthal estimates
that less than half these patients get optimal treatment
because of the complexity of monitoring and implementing
multidrug and lifestyle treatments.
The study was funded by the Maryland Athletic Club
Charitable Foundation in Lutherville, Md. Other authors are
Ty Gluckman, Molly Sachdev and Steven Schulman, all from
Johns Hopkins.
Gluckman has received honoraria from Pfizer and
Aventis Pharmaceuticals. Schulman and Blumenthal have
received honoraria from Bristol-Myers Squibb,
GlaxoSmithKline and Pfizer.
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