The government of Australia accords a lot of importance to acute coronary syndrome (ACS). As a result, it has adopted different versions of guidelines for the management of ACS. These include the National Heart Foundation of Australia (NHFA) and Cardiac Society of Australia and New Zealand (CSANZ) Guidelines for the management of acute coronary syndromes 2006 and its 2007 and 2011 addendums, among other guidelines.
According to the 2006 guidelines for the management of acute coronary syndromes, people with ACS symptoms are supposed to seek help promptly. The guidelines also provide that such people should activate emergency medical services and be able to access a defibrillator. This is because reversible arrhythmias could lead to cardiac death. If aspirin has not been taken or contraindicated, it should be given early enough. The guidelines also provide that the facilities should be available to ACS patients, such as Mark, and others who have unstable conditions. In addition, if necessary, oxygen, intravenous morphine and glycerol trinitrate should be given. With regard to the situation of the patient, there should be pre-hospital treatment or a 12-point electrocardiogram (ECG) transmitted.
The 2007 addendum was meant to supplement the recommendations of the National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand. The addendum offers additional information on how ACS patients should be managed. Out of additional research, the 2007 addendum recommended that patients who do not reperfuse in 90 minutes following fibrinolytic therapy should be considered for percutaneous coronary intervention (PCI). According to these guidelines, the PCI should be performed in 12 hours. Consequently, there should be adequate facilities to facilitate the transfer from one hospital to another. Other than reperfusion, the guidelines also provide for management of ACS under revascularization and anti-platelet and anti-thrombin therapy. Lastly, the recommendations of the 2011 addendum to the 2006 NHFA and CSANZ were based on serum troponin measurements, choice of reperfusion therapy for STEMI, antithrombotic therapy for NSTEACS and bleeding risks in ACS. It recommends that body evidence in grades A to D could be used to guide the management of ACS patients.
Other than the NHFA, the CSANZ and the two addendums, there are other evidence-based guidelines for the management of ACS patients. In 2009, the Department of Health in Western Australia investigated the subject and also came up with its own guidelines. Moreover, to some extent, they borrowed from the 2006 guidelines as developed by the above two bodies. In its guidelines, the Department of Health in Western Australia Health recommends a model of care for ACS patients. It recommends that patients should be encouraged to recognize ACS on their own, seek medical services, and receive early diagnosis and state-wide coordination of ACS care. In addition, out of a thorough investigation by 12 researchers, the International Liaison Committee on Resuscitation Task Force recommended that such patients should be well categorized either as STEMI or NSTEMI.
Recommended Resources for Patients and Family to Learn about ACS
The advancement of information technology has improved information dissemination to the public immensely. Specifically, internet has brought about a revolution in the way registered nurses as well as other health scientists and institutions deliver their message to the patients. In most cases, health organizations, institutions or professionals disseminate patient information via websites, blogs and other reputable online resources. With regard to ACS, massive literature is available in websites. This literature is specifically designed for the public, the patients and their families.
The Auckland Heart Group’s website has a section on ACS. This section is designed to help patients know what ACS is, the types of heart attacks, how ACS is diagnosed, treatment options and risk factors. For instance, some of the treatment options include treating the primary problem, re-establishing the supply of blood to prevent further damage of the heart muscle, stabilizing the ‘hot areas’ and preventing further complications. The website presents some of the risk factors as diabetes mellitus, smoking and high blood pressure.
The University of Maryland Medical Centre also has patient information section in its website. The section, entitled ‘patient education’, explains how ACS could be rehabilitated. According to the site, ACS patients could be rehabilitated either physically or emotionally. It also gives information on the condition, associated risk factors, prognosis, symptoms, diagnosis, treatment, medications and secondary prevention.
Patient.co.uk (2012) also provides trusted medical information and patient support on ACS. From this site, a patient can obtain detailed information on what ACS is as a disease, the anatomy of the heart, causes of ACS, people at risk of acquiring ACS, its symptoms and its treatment. This site is particularly user friendly.
There are other reputable websites, to which nurses could refer patients with ACS condition. The American College of Surgeon’s Division of Education (2012) is the website, which provides highly detailed patient information on ACS. It presents ACS patient information from a surgical perspective. The website offers general information on ACS, how to find surgeons, resources on medication and pain related to ACS, as well as public education tips, among others.
Another reputable site is that of Mayo Clinic. The website provides relevant information on the remedies that could help ACS patients from home. It recommends that such patients should not smoke and should take heart-healthy diet. In addition, they should exercise regularly and check their levels of cholesterol. These recommendations are directly related to heart health. Others include controlling blood pressure, maintaining a healthy weight, effectively managing stress and taking alcohol in moderation. Lastly, the American Heart Association website provides patient information sheets related to heart attack. Three of these patient information sheets include explanations on what heart attacks are, how to recover from them and some of the warning signs of ACS.
- Discharge Summary for Mark
According to Chang, Daly and Elliott (2006), post-discharge management for ACS patients is particularly vital. This is because, among other reasons, the condition has to do with the heart; hence it is extremely critical. In the case of Mark, an expansive management plan will be implemented. This discharge summary will, therefore, include long-term management plan. The plan will cover medicines management plan, chest-pain action plan and secondary prevention programs. The plan will be well communicated to those who will take care of Mark, as well as community healthcare providers. According to Kucia and Quinn (2009), a well designed medicines management plan should not only include a list of medicines but also a plan for close titration, intended therapy duration, benefits of therapy, probable effects of each medicine, follow up and monitoring schedule and information on consumer medicine. This is also in line with what the NHFA and CSANZA provides for in the 2006 guidelines and their successive addendums. In line with the latter, the discharge would include warning signs of heart attack, the time and mode of taking the short-acting nitrate, how to self-administer aspirin and how to reach the ambulance services. In terms of secondary prevention management, the discharge will include recommendations for attendance of secondary prevention programs and lifestyle goals such as cessation of smoking. The discharge will also include information on social availability or importance of social support groups.
Specifically, Mark will receive management on discharge medicine counseling, recommendations for smoking cessation and also referral for secondary prevention. According to Gelfand and Cannon, referral to cardiac rehabilitation may not be necessary, if the patient is well attended. However, referral for secondary prevention program is always truly essential. Mark will be referred to a social group near his residence. This will be expected to help in psychological comfort and sharing of information with other patients. Lastly, other than the management and referral information, the discharge program includes to whom the management plan would be communicated, either patient or the GP. Lastly, the discharge considers the officer who discharges Mark, documentation, list of medicines and risk factors modification.