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SIGN Heart Disease Guidelines Five national clinical guidelines sign.ac.uk

SIGN Heart Disease Guidelines Five national clinical guidelines www.sign.ac.uk. Key points - prevention. everyone over 40 years old in Scotland should be assessed for risk of CHD (and stroke) at least every five years.

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SIGN Heart Disease Guidelines Five national clinical guidelines sign.ac.uk

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  1. SIGN Heart Disease Guidelines Five national clinical guidelines www.sign.ac.uk

  2. Key points - prevention • everyone over 40 years old in Scotland should be assessed for risk of CHD (and stroke) at least every five years. • 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.

  3. Key points – treatment (1) • 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 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 and be evaluated for possible angioplasty and stenting.

  4. Key points – treatment (2) • 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.

  5. SIGN 93 - Acute coronary syndromes SIGN 94 - Cardiac arrhythmias in coronary heart disease SIGN 95 - Management of chronic heart failure SIGN 96 - Management of stable angina SIGN 97 - Risk estimation and the prevention of cardiovascular disease National clinical and resource impact assessment The 5 CHD guidelines

  6. Development of the guideline • Involved 105 NHS and voluntary sector staff and patients and carer representatives from all over Scotland • Uses SIGN evidence-based methodology • Initial literature searches based on 130 key questions identified130,000 research papers • 3,000 relevant published papers up to the end of 2005 were reviewed • 5 multidisciplinary groups reviewed the evidence • Formal review by 131 peer reviewers

  7. Levels of evidence

  8. Levels of evidence

  9. Levels of evidence

  10. Grades of recommendation • Relate to strength of evidence, not clinical importance • Low grade recommendations in important clinical areas should stimulate research

  11. Grades of recommendation

  12. Grades of recommendation

  13. Grades of recommendation Remember – grades relate to strength of evidence, not clinical importance

  14. Grades of recommendation

  15. Summary The SIGN CHD guidelines are based on evidence and were developed using a recognised methodology

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