Introduction
Coronary heart disease (CHD) and acute coronary syndrome (non-ST-segment elevation myocardial infarction [NSTEMI], unstable angina [UA], and ST-segment elevation myocardial infarction [STEMI]) are common and costly causes of morbidity and mortality in the United States. In 2005, more than 1.4 million Americans were hospitalized with acute coronary syndrome (ACS).[1] The estimated direct medical costs and indirect costs for lost productivity, morbidity, and mortality from CHD in the United States were expected to exceed $156 billion in 2008.[1]
Antithrombotic therapies (antiplatelet and anticoagulant drugs) play an important role in the management of ACS. Recently updated evidence-based guidelines for the management of ACS that address antithrombotic therapies are available from various authoritative sources, including the American College of Cardiology (ACC), American Heart Association (AHA), and American College of Chest Physicians (ACCP).[2-5] These guidelines reflect recently published results of studies comparing therapeutic regimens involving antithrombotic agents.
Data from a national quality improvement initiative known as CRUSADE designed to assess and improve adherence to guidelines for managing non-ST-segment elevation ACS reveal that the management of ACS often is less than optimal.[6] These observations suggest that translating evidence-based guidelines and new clinical research findings into clinical practice can present a challenge to clinicians. Data from the Global Registry of Acute Coronary Events demonstrate that improvements in the management of ACS translate into improved patient outcomes.[7] This activity illustrates the application of evidence-based guidelines for the management of ACS and new clinical research data to improve outcomes in specific patient cases.
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