Heart Disease :: New heart disease guidelines could save 7000 lives

More than 7,000 deaths and 27,000 cardiovascular events, such as heart attacks, can be avoided over the next five years by modernising the prevention and treatment of coronary heart disease (CHD), the Scottish Intercollegiate Guidelines Network (SIGN) said.

CHD ? a disease of the heart and coronary arteries caused by a build-up of fatty materials in the arteries – is the leading cause of death in Scotland with more than 10,000 people dying of the condition in 2005/6 (source: ISD Scotland). Significant progress in reducing the number of deaths has, however, been made in recent years with a fall of almost 30 per cent since 1996, in part due to the implementation of previous SIGN CHD guidelines.

Factors that increase the risk of cardiovascular disease (CVD) – include smoking, poor diet, lack of exercise and alcohol consumption. The new guidelines from SIGN, part of NHS Quality Improvement Scotland (NHS QIS), examine the latest scientific evidence and make detailed recommendations that will improve the prevention, management and treatment of the condition.

The guidelines? key recommendations on prevention include:

– everyone over 40 years old in Scotland should be assessed for risk of CHD (and stroke) at least every five years. However, the guidelines note that NHSScotland is developing a new risk assessment tool, (derived from Scottish data) that will include family history, detailed smoking habit, and social deprivation as additional risk factors
– lifestyle advice, should be given to everyone at such assessments
– more people should be considered for statin drugs to reduce cholesterol levels before they have an event (including people with a risk of CHD or stroke of 20 per cent or more over 10 years, rather than the previous recommendation of 30 percent or more for CHD alone), as well as low-dose aspirin which reduces the risk of blood clots.

The guidelines? key recommendations on treatment include:

– patients with the most serious type of heart attack (ST elevation acute coronary syndrome) should be admitted to a regional cardiac intervention laboratory to remove the causal blood clot and narrowed artery (angioplasty) and implant a stent (a small porous mesh) to keep the artery open. If this is not possible within 90 minutes of diagnosis, they should rapidly receive the most effective clot-busting drugs (thrombolytics).
– high risk patients with non-ST elevation acute coronary syndrome should receive early angiography (heart X-rays) and be evaluated for possible angioplasty and stenting.
– more patients with arrhythmias and heart failure should receive implantable cardiac defibrillators (ICDs) and cardiac resynchronisation therapy (CRT), to reduce the risk of sudden death.
– discharge arrangements for patients hospitalised with heart failure should be improved, to augment the existing primary care services.

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