Issues in discharge therapy after hospitalization for UA/NSTEMI
1 Martini Hospital, Groningen, The Netherlands
2 Royal Brompton Hospital, London, U.K.
3 St. Luke's/Roosevelt Hospital and Columbia University, New York, New York, USA
4 University of Alabama Medical Center, Birmingham, Alabama, USA
* Correspondence: Peter J. L. M. Bernink, Martini Hospital, Groningen, The Netherlands.
Abstract
New treatment guidelines for the management of unstable angina and non-ST-segment elevation myocardial infarction were recently issued by the ACC/AHA and the ESC. Both sets of guidelines include recommendations for discharge therapies, and discuss the importance of aggressive risk management, as well as the use of medications, including aspirin, ß-blockers, lipid-lowering agents, and angiotensin-converting enzyme (ACE) inhibitors. These new recommendations were the subject of workshops held in September 2000, at the 4th Annual Experts' Meeting of the International Cardiology Forum. In general, workshop participants found the new ACC/AHA and ESC guidelines to be useful and consistent with practice. However, there were conflicting views on a number of topics, such as who should be treated with lipid-modifying medications, and whether the indications for ACE inhibitors should be expanded. The discussions also identified several areas of discharge management where more definitive trial data would be helpful. Some participants felt that the incremental benefit of individual agents in multidrug regimens has not yet been clearly established. There was also concern that, as the number of effective therapies increases, lack of patient compliance and financial constraints may impose greater limitations on guidelines implementation.
Key Words: Unstable angina • discharge therapy • guidelines • ACE inhibitors