Preventing recurrent events in survivors of acute coronary syndromes in Australia: consensus recommendations using
Christopher J Hammett1, John Amerena2, David Brieger3
1a Department of Cardiology , Royal Brisbane and Women's Hospital , Brisbane , QLD , Australia.
Insights
Australian experts developed practical recommendations to improve medication use after acute coronary syndromes (ACS). These guidelines aim to reduce recurrent cardiovascular events by bridging the gap between evidence-based care and clinical practice for ACS patients.
Area of Science:
- Cardiology
- Evidence-based medicine
Background:
- Significant gaps exist in implementing evidence-based care for acute coronary syndromes (ACS) in Australia.
- These implementation gaps contribute to high rates of recurrent cardiovascular events.
Purpose of the Study:
- To develop straightforward, actionable recommendations for key medications post-ACS.
- To improve the translation of evidence into effective clinical action for Australian ACS patients.
Main Methods:
- A modified Delphi technique was employed, involving a steering committee and a panel of 21 expert cardiologists.
- Experts voted on consensus statements regarding medication use, with revisions and re-voting for non-consensus items.
Main Results:
- Twenty-eight statements were developed across six medication classes: LDL-lowering agents, aspirin, dual antiplatelet therapy, RAAS inhibitors, beta-blockers, and others.
- Twenty-six recommendations achieved consensus (≥80% agreement) from the expert panel.
Conclusions:
- Despite existing guidelines, a gap persists in translating best practices into routine care for ACS patients.
- These consensus recommendations offer a practical approach to enhance evidence-based medication use, aiming to reduce future cardiovascular events in Australia.
Objective:
There remain substantial gaps in implementation of evidence-based care in patients with acute coronary syndromes (ACS) in Australia, which contribute to high recurrent event rates. Improved translation of evidence into effective action is a key health-care priority. We engaged cardiovascular experts from across Australia to develop straightforward, easily actionable recommendations on key medications to use following ACS.
Methods:
An eight-person steering committee (SC) reviewed the published evidence and developed an initial set of statements to be developed into consensus recommendations using a modified Delphi technique. A panel of 21 expert cardiologists in the ACS field (including the SC) voted on their level of agreement with the statements using a 6 point Likert scale. Statements that did not reach consensus (≥80% agreement) were reviewed by the SC, modified as appropriate based on input from the panel and circulated for re-voting.
Results:
Twenty-eight statements were developed by the SC across six classes of medication: low-density lipoprotein (LDL) cholesterol lowering agents, aspirin, dual antiplatelet therapy, renin-angiotensin-aldosterone system inhibitors, beta blockers and "other". Twenty-six recommendations were endorsed by the voting panel; two statements did not reach consensus.
Conclusions:
Despite the extensive evidence base and detailed guidelines outlining best practice post ACS, there remain considerable gaps in translating these into everyday care. We used an internationally recognized technique to develop practical consensus recommendations on medical treatment following ACS. These simple, up-to-date recommendations aim to improve evidence-based medication use and thereby reduce the risk of future cardiovascular events for Australian patients with ACS.
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