Post-discharge and long-term follow-up after an acute coronary syndrome: International Collaborative Group of CNCF position paper.

Abstract

IntroductionLong-term follow-up after an acute coronary syndrome (ACS) presents a crucial challenge due to the high residual cardiovascular risk and the potential for major bleeding events. Although several treatment strategies are available, this article focuses on patients who have undergone percutaneous coronary intervention (PCI) for ACS, which represent a frequent clinical situation. This position paper aims to support physicians in daily practice to improve the management of ACS patients.Material and methodsA group of recognized international and French experts in the field, provides an overview of current evidence-based recommendations − supplemented by expert opinion where such evidence is lacking − and a practical guide for the management of patients with ACS after hospital discharge.ResultsThe International Collaborative Group underlines the need of a shared collaborative approach, and a care plan individualized to the patient’s risk profile for both ischemia and bleeding. Each follow-up appointment should be viewed as an opportunity to optimize the personalized approach, to reduce adverse clinical outcomes and improve quality of life. As risks – both ischaemic and haemorrhagic – evolve over time, the risk–benefit balance should be assessed in an ongoing dynamic process to ensure that patients are given the most suitable treatment at each time point.ConclusionsThis Expert Opinion aims to help clinicians with a practical guide underlying the proven strategies and the remaining gaps of evidence to optimize the management of coronary patients.

2022: The Year in Cardiovascular Disease – The Year of Upfront Lipid Lowering Combination Therapy.

“…The first is obviously associated with too few patients being treated with combination therapyand in particular, insufficient use of upfront combination LLT. This is despite our International Lipid Expert Panel (ILEP) recommendations on upfront combination therapy, which were published in April 2021 14 , and the reiteration of the advice in the European Atherosclerosis Society (EAS) Task Force paper 18 as well as an expert opinion paper published in EHJ 19 , and at least several national guidelines in which this approach was approved (e.g., in Poland, Spain, France) 7,[20][21][22] . Another reason for limited goal achievement is related to the fact that when non-statin drug(s) are added to statin therapy, the statin dose is reduced at the same time in many patients, and/or ezetimibe is discontinued in case of triple therapy with a PCSK9 targeted therapy approach.…”

A Systematic Review of Lipid Management in Secondary Prevention and Comparison of International Lipid Management Pathways

“…A major difference in this study compared to the other was that cardiac rehabilitation nurses were responsible for optimizing lipid-lowering therapy in patients who had not achieved target LDL-C levels [ 3 , 7 ]. A Danish population-based study based on 4377 patients with a mean age of 67.8 ± 13.6 showed that 89.4% of patients had LDL-C > 1.8 mmol/L at the time of ACS [ 9 - 11 ]. In comparison to other European countries, patients with ACS in Austria are generally followed up in the community for lipid-lowering therapy optimization and only patients with severely reduced left ventricular ejection fraction are followed up in a hospital setting [ 3 , 12 ].…”

Trimetazidine After Coronary Revascularization: Much Ado About Nothing?

“…Antithrombotic therapy has been for years the mainstay to prevent disease relapses, but nowadays several other drugs have proven to be effective in decreasing overall cardiovascular risk and major adverse cardiovascular events, even after an acute coronary syndrome. 3 Prevention of heart failure (HF) with prompt revascularization when amenable and aggressively tackling risk factors have been shown to be particularly effective, given the detrimental interplay among these clinical entities. 4 Intriguingly, metabolic derangements in myocardiocytes stem from an imbalance in myocardial energy consumption and reduced oxygen supply, because of decreased blood flow in CAD, resulting in myocardial ischemia.…”

“…Antithrombotic therapy has been for years the mainstay to prevent disease relapses, but nowadays several other drugs have proven to be effective in decreasing overall cardiovascular risk and major adverse cardiovascular events, even after an acute coronary syndrome. 3…”