Non-ST-segment elevation acute coronary syndrome: impact of nursing care on optimal outcomes

Of the nearly 1.4 million hospitalizations for acute coronary syndromes in 2006, approximately two-thirds were for unstable angina (UA) or non-ST-segment elevation myocardial infarction (NSTEMI). Given the high risk for in-hospital ischemic events and late mortality in patients with UA/NSTEMI, it is critical to accurately and rapidly diagnose these patients, stratify their level of risk, and provide appropriate pharmacologic and nonpharmacologic treatment that maximizes anti-ischemic benefit and minimizes risk of bleeding. Appropriate in-hospital care following intervention is critical for optimizing both short- and long-term outcomes. However, evidence suggests that up to 26% of opportunities to provide guidelines-recommended care are missed. Nurses can play a critical role in ensuring that patients receive guidelines-based care. This review examines the most recent recommendations for the diagnosis and pharmacologic management of patients with UA/NSTEMI and discusses ways in which nursing staff can contribute to minimizing patient risk and optimizing patient benefit.