New guidelines simplify treatment of chest pain

AORN Journal,  May, 2005  

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Simplified guidelines for managing patients with acute coronary syndrome (ie, chest pain at rest or with mild exertion) can help ensure that risk-reducing strategies are followed by physicians and other caregivers of patients with this medical condition, according to a Jan 18, 2005, news release from Johns Hopkins Medicine, Baltimore. To develop the guidelines, researchers reviewed relevant peer-reviewed medical publications from 1990 to 2004 to assess the most effective and safe practices for treatment. They concluded that when patients who are most likely to benefit from either an early invasive or early conservative strategy are identified, a comprehensive management plan using a simple "ABCDE" approach can be applied.

The new guidelines are based on those developed by the American Cortege of Cardiology, the American Heart Association (AHA), and results of recent clinical trials and include risk-factor reduction, lifestyle changes, and medications. The "alphabet" approach includes

* "A" for antiplatelet therapy, anticoagutation, angiotensin converting enzyme inhibition, and angiotensin receptor blockade;

* "B" for beta-blockade and brood pressure control;

* "C" for cholesterol treatment and cigarette smoking cessation;

* "D" for diabetes management and diet; and

* "E" for exercise.

For the study, researchers focused on one type of coronary artery disease, called non-ST-segment elevation acute coronary syndrome. According to the AHA, acute coronary syndrome describes a group of clinical symptoms associated with chest pain caused by insufficient blood supply to the heart muscle because of dogged arteries. Non-ST-segment elevation acute coronary syndrome is a common form of this disease and a major cause of emergency care and hospitalization in the United States.

Simpler "Alphabet" Guidelines for Treating Acute Coronary Syndrome Reduce Risk (news release, Baltimore: Johns Hopkins Medicine, Jan 18, 2005) http://www.hopkinsmedicine.org/ Press_releases/2005/01_18_05.html (accessed 25 Jan 2005).

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