Forge 1 has raised specific concerns about our recent position statement2 on implementing the National Heart Foundation of Australia (NHFA)/Cardiac Society of Australia and New Zealand (CSANZ) consensus recommendations for managing patients with acute coronary syndromes (ACS).3 In particular, he questions whether providing all patients with equal access to percutaneous coronary intervention (PCI) services is truly evidence-based.
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- 1. Forge BH. The “Acute coronary syndromes: consensus recommendations for translating knowledge into action” position statement is based on a false premise. Med J Aust 2010; 192: 696-699. <MJA full text>
- 2. Brieger D, Kelly A-M, Aroney C, et al; National Heart Foundation ACS Implementation and Advocacy Working Group. Acute coronary syndromes: consensus recommendations for translating knowledge into action. Med J Aust 2009; 191: 334-338. <MJA full text>
- 3. Acute Coronary Syndrome Guidelines Working Group. Guidelines for the management of acute coronary syndromes 2006. Med J Aust 2006; 184 (8 Suppl): S1-S32. <MJA full text>
- 4. Unstable Angina Working Group. Management of unstable angina. Guidelines — 2000. Med J Aust 2000; 173 Suppl: S65-S88.
- 5. de Winter RJ, Windhausen F, Cornel JH, et al; Invasive versus Conservative Treatment in Unstable Coronary Syndromes (ICTUS) Investigators. Early invasive versus selectively invasive management for acute coronary syndromes. N Engl J Med 2005; 353: 1095-1104.
- 6. National Institute for Clinical Excellence Guideline Development Group. Unstable angina and NSTEMI: the early management of unstable angina and non-ST-segment-elevation myocardial infarction. http://www.nice.org.uk/guidance/CG94/Guidance (accessed May 2010).
- 7. Walters DL, Aroney CN, Chew DP, et al. Variations in the application of cardiac care in Australia: results from a prospective audit of the treatment of patients presenting with chest pain. Med J Aust 2008; 188: 218-223. <MJA full text>
- 8. Anderson JL, Adams CD, Antman EM, et al. ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients with Unstable Angina/Non-ST-Elevation Myocardial Infarction) developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine. J Am Coll Cardiol 2007; 50: e1-e157. Erratum in: J Am Coll Cardiol 2008; 51: 974.
- 9. Task Force for Diagnosis and Treatment of Non-ST-Segment Elevation Acute Coronary Syndromes of European Society of Cardiology, Bassand JP, Hamm CW, Ardissino D, et al. Guidelines for the diagnosis and treat-ment of non-ST-segment elevation acute coronary syndromes. Eur Heart J 2007; 28: 1598-1660.
- 10. Di Mario C, Dudek D, Piscione F, et al; CARESS-in-AMI (Combined Abciximab Reteplase Stent Study in Acute Myocardial Infarction) Investigators. Immediate angioplasty versus standard therapy with rescue angioplasty after thrombolysis in the Combined Abciximab Reteplase Stent Study in Acute Myocardial Infarction (CARESS-in-AMI): an open, prospective, randomised, multicentre trial. Lancet 2008; 371: 559-568.
- 11. Cantor WJ, Fitchett D, Borgundvaag B, et al. Routine early angioplasty after fibrinolysis for acute myocardial infarction. N Engl J Med 2009; 360: 2705-2718.
- 12. Jaeschke R, Guyatt GH, Dellinger P, et al; GRADE Working Group. Use of GRADE grid to reach decisions on clinical practice guidelines when consensus is elusive. BMJ 2008; 337: a744.
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The authors are all members of the NHFA ACS Guideline Implementation and Advocacy Working Group. David Brieger has been a member of advisory boards for Sanofi-Aventis, Eli Lilly, AstraZeneca and Boehringer Ingelheim, and has received research grants from Sanofi-Aventis, Eli Lilly, Schering-Plough and Merck Sharp & Dohme. Constantine Aroney has received reimbursement for travel/accommodation expenses from Sanofi-Aventis, Eli Lilly and Medtronic and payment for developing educational presentations from Eli Lilly, Pfizer and The Medicines Company. Derek Chew has been a board member for Sanofi-Aventis, Eli Lilly and AstraZeneca, and has received reimbursement for travel/accommodation expenses from AstraZeneca and fees for expert testimony from Sanofi-Aventis and Eli Lilly. Anne-Maree Kelly has been on advisory boards for Sanofi-Aventis, AstraZeneca and Medical Developments International, and has received reimbursement for travel/accommodation expenses from Radiometer. Darren Walters has received a research fellowship from Medtronic and reimbursement of travel/accommodation expenses from Eli Lilly, AstraZeneca, Medtronic, GlaxoSmithKline, Johnson & Johnson, Universal Biosensors, Boston Scientific and Abbott Australasia, as well as organisations including the American Heart Association, the Royal Australasian College of Physicians and CSANZ. Carrie Toohey is employed by the NHFA and has received institutional funding from CSANZ and the Australasian College of Emergency Medicine. Andrew Boyden is employed by the NHFA.