The "Acute coronary syndromes: consensus recommendations for translating knowledge into action" position statement is based on a false premise.
Recent National Heart Foundation of Australia (NHFA) guidelines for management of acute coronary syndromes (ACS) recommend increasing the rates of early invasive management of ACS and providing equal access for all Australians to percutaneous coronary intervention (PCI) facilities. For patients with ACS managed in regional hospitals without PCI facilities, review of the evidence does not show unequivocal benefit of early routine PCI over selective PCI for patients with non-ST-segment-elevation ACS or ST-elevation myocardial infarction. The current pattern of transfer based on the NHFA guidelines is expensive and disruptive of patient care, as well as undermining regional health care services. Further increase in transfer rates and increases in PCI facilities would divert resources away from supporting the regional infrastructure needed to provide evidence-based therapies, without any evidence that lives would be saved.
Forge
Brett H
BH
West Gippsland Hospital, Warragul, VIC, Australia. bforge@absoluterisk.com
D006801:Humans; D054058:Acute Coronary Syndrome / Q000188:drug therapy / Q000601:surgery; D000789:Angina, Unstable / Q000188:drug therapy / Q000601:surgery; D006328:Cardiac Catheterization / Q000592:standards; D004562:Electrocardiography; D019317:Evidence-Based Medicine / Q000592:standards; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D009203:Myocardial Infarction / Q000188:drug therapy / Q000601:surgery; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D012017:Referral and Consultation / Q000592:standards; D012306:Risk; D003245:Consensus Statements as Topic
D005343:Fibrinolytic Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors