February 16, 2009
Thank you for taking the time to review these instructional materials.
In spite of decades of research, coronary disease remains the number one cause of death in North America. While the challenge of coronary disease is daunting, we are fortunate to have several medical and procedural interventions which reduce the lethality of Acute Coronary Syndromes (ACS). Our colleagues who treat solid tumors and degenerative neurological diseases would love to be in the cardiologist's enviable position of having several interventions each one of which reduces mortality by 20 - 40%.
In the treatment of ACS, if an intervention is to improve mortality, it must be given promptly - time is muscle. All too often, medicines with demonstrated therapeutic effect are given too late or withheld entirely. I include below a paper illustrating this point.
Karen Armstrong and her colleagues reviewed the charts of patients who presented to hospitals with ACS and were enrolled in the GUSTO-IIB Trial (JACC 1998; 32, 2023-30). Dr. Armstrong compared actual treatment with Aspirin, Beta-blocker, ACE Inhibitors (which were generally indicated); and Calcium Channel Blockers (which were generally contraindicated) with guidelines recommendations. Her conclusion was that had physicians adhered more closely to published guidelines, the observed mortality rate in GUSTO-IIB could have been lowered by an additional 22%. It is in an effort to prevent these unnecessary deaths that hospitals around the country have instituted pre-printed order sets, pre-printed discharge instructions, Emergency Department protocols, and instructional resources such as this one.
Thank you again for your commitment to our patients. If you see some way that we could improve our treatment of ACS patients, please do not hesitate to call. The Chest Pain Center Coordinator, Clinical Nurse Specialist in Cardiology, Kathy Fry, RN MS, can be reached at extension 8809. I can be reached at extension 8989.
Reed D. Riley, MD
Cardiology Division Chief
Greater Baltimore Medical Center
Assistant Professor of Medicine
The Johns Hopkins University School of Medicine