title: Secondary Prevention Beyond Hospital Discharge for Acute Coronary Syndrome: Evidence-Based Recommendations.
abstract: In the past 3 decades, a better understanding of the pathophysiology of cardiovascular disease has resulted in innovations in the treatment and prevention of its clinical manifestations such as death, myocardial infarction, or stroke. After an acute coronary syndrome there are short- and long-term risks of subsequent cardiovascular events. This leads to opportunities to initiate strategies to reduce complications resulting from myocardial injury (cardiac protection) and to prevent recurrent acute coronary events (vascular protection). The results from clinical trials inform best practice and guidelines for patient management. Despite clear and consistent guidelines, an important number of patients are not receiving these treatments. Moreover, many others do not receive treatment that follows the strategy proven in the clinical trial and this is associated with a significant loss of opportunities to improve outcomes. The Canadian Heart Research Centre has therefore assembled a panel of experts to provide a review of available data and distill it to specific evidence-based recommendations that can be used by specialists and primary care physicians as a platform for secondary prevention. The therapeutic recommendations are conveniently divided into vascular protection (dual antiplatelet therapy, lipid-lowering, and renin angiotensin system inhibition) which should be considered in all patients; cardiac protection (addition of β-blocker therapy) in patients with left ventricular dysfunction including consideration for management of heart failure; and continuing management of risk factors and comorbid conditions on the basis of the specific patient profile. These recommendations are intended as a decision support tool and a quick reference for Canadian physicians.
authors.affiliation: St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. Electronic address: fitchettd@smh.ca.
authors.forename: David H
authors.initials: DH
authors.lastname: Fitchett
authors.affiliation: St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Canadian Heart Research Centre, University of Alberta, Edmonton, Alberta, Canada; Vigour Centre, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Shaun G
authors.initials: SG
authors.lastname: Goodman
authors.affiliation: St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Lawrence A
authors.initials: LA
authors.lastname: Leiter
authors.affiliation: Canadian Heart Research Centre, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Peter
authors.initials: P
authors.lastname: Lin
authors.affiliation: Vigour Centre, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Robert
authors.initials: R
authors.lastname: Welsh
authors.affiliation: University of Calgary, Calgary, Alberta, Canada.
authors.forename: James
authors.initials: J
authors.lastname: Stone
authors.affiliation: Montreal Heart Centre, University of Montreal, Montreal, Quebec, Canada.
authors.forename: Jean
authors.initials: J
authors.lastname: Grégoire
authors.affiliation: St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Philip
authors.initials: P
authors.lastname: Mcfarlane
authors.affiliation: St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Canadian Heart Research Centre, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Anatoly
authors.initials: A
authors.lastname: Langer
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications / Q000401:mortality / Q000517:prevention & control*; D000319:Adrenergic beta-Antagonists / Q000009:adverse effects / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D002170:Canada; D002423:Cause of Death; D016757:Death, Sudden, Cardiac / Q000517:prevention & control; D004359:Drug Therapy, Combination; D019317:Evidence-Based Medicine; D005544:Forecasting; D019983:Guideline Adherence; D006333:Heart Failure / Q000401:mortality / Q000517:prevention & control; D006801:Humans; D000960:Hypolipidemic Agents / Q000009:adverse effects / Q000627:therapeutic use; D010351:Patient Discharge; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D058996:Quality Improvement / Q000639:trends; D012084:Renin-Angiotensin System / Q000187:drug effects; D012307:Risk Factors; D055502:Secondary Prevention
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000960:Hypolipidemic Agents; D010975:Platelet Aggregation Inhibitors