NSTE-ACS Medication Management Quiz

Clinical Practice Guidelines - Management of Non-ST Elevation Myocardial Infarction (NSTE-ACS)

• This is a combination of unstable angina (UA) and non-ST elevation myocardial infarction (NSTEMI)
• The guidelines aim for best clinical practice in the management of NSTE-ACS
• Adherence to guidelines does not guarantee the best clinical outcome for every patient. Clinicians should use local/personal knowledge and clinical presentation in conjunction with guideline recommendations.

Statement of Intent

• The guidelines were developed to be a guide for best clinical practice in the management of Non-ST Elevation Acute Coronary Syndrome (NSTE-ACS)
• The guidelines are based on the best available current evidence
• Adherence to these guidelines does not guarantee the best outcome in every patient
• Clinicians should consider individual patient presentation, locally available options, and clinical expertise.

Review of Guidelines

• The guidelines were issued in 2021
• They will be reviewed in 2026 or earlier if significant new evidence becomes available

CPG Secretariat

• Located in Level 4, Block El, Parcel E, Government Offices Complex, 62590 Putrajaya, Malaysia
• Information available on these websites:
  • http://www.malaysianheart.org
  • http://www.moh.gov.my
  • http://www.acadmed.org.my
• This document updates previous guidelines on UA/NSTEMI (2002, 2011)

Message from the Director General of Health

• Non-ST Elevation Acute Coronary Syndrome (NSTE-ACS) accounts for 55.4% of all Acute Coronary Syndromes (ACS) in Malaysia from 2016 to 2017
• Ensuring standardized clinical management is paramount for patient safety
• Improvements in ACS management over the last decade are highlighted
• Updates to diagnostic and therapeutic measures have been introduced since the 2011 NSTE-ACS guidelines
• This 2021 guideline is timely, covering the pre-hospital care, use of troponin, risk stratification, and early invasive strategy

Members of the Expert Panel & External Reviewers

• Lists of various consultants, specialists, and healthcare professionals from public and private sectors in Malaysia who were involved in developing the guidelines

Rationale and Process of Guidelines Development

• Ischemic Heart Disease (IHD) the leading cause of death in Malaysia
• This guideline has been developed based on evidence and expert reviews from the National Heart Association of Malaysia (NHAM) and Ministry of Health (MOH) and external reviewers.
• The guideline aims to improve the management of NSTE-ACS and reduce risk of adverse outcomes.
• Systematic reviews, expert agreement, and public comment influenced this document.
• The American College of Cardiology Foundation/American Heart Association and other international guidelines used for development considerations.
• The Appraisal of Guidelines for Research and Evaluation (AGREE II) Tool used as part of the guidelines development.

Grades of Recommendation and Levels of Evidence

• The guidelines use a standardized grading system to assess evidence
• Levels of evidence are given for each guideline recommendation

List of Abbreviations

• A list of abbreviations used throughout the guidelines

Summary

• Provides a concise overview of the main points of the guidelines.
• Concise overview of the epidemiology, definition, diagnosis, pathogenesis and strategies used in the guidelines.

Key Messages

• Essential takeaways from the guidelines.

Key Recommendations

• Summarizes the core recommendations for managing NSTE-ACS.

Flowcharts and Tables

• Includes clinical guidelines for diagnosis and management, with decision support tools

Introduction of Terms

• Defines NSTE-ACS, UA and NSTEMI
• Definitions for relevant medical terms

Pathogenesis

• Details the processes leading to NSTE-ACS, focusing on the pathophysiology of NSTE-ACS.

Diagnosis

• Covers the diagnostic steps/process for NSTE-ACS, including information about history, physical examination, electrocardiography, and cardiac biomarkers

Risk Scores

• Provides details on patient risk stratification scores used to classify risk levels in NSTE-ACS
• The method of calculating different risk scores and use of each score in varying stages of NSTE-ACS

Pre Hospital Management

• Details of the immediate pre-hospital steps that should be taken

In-Hospital Management

• Information on the necessary in-hospital management required for NSTE-ACS
• Addresses various crucial issues like the evaluation, monitoring, and procedures in the ED

NSTE-ACS in Special Groups

• Details on considerations for certain populations like older individuals, women, and those with chronic kidney disease.

Post Hospital Discharge

• Advice on post-discharge patient care (especially on medication, follow-up, and rehabilitation)

Monitoring of Activity & Quality Assurance

• Discusses strategies to ensure consistent quality of care throughout the guideline implementation

External Reviewers

• List of external experts involved in reviewing the content of guidelines for possible bias and quality of content