A handy guide to coronary care

Clinicians working in the area of coronary care have the luxury of an enormous evidence base to guide their decision-making. Many of the so-called megatrials which have defined the modern era of evidence-based medicine were designed to answer important questions in acute coronary care. Making use of this evidence and applying it to patient care is a daily challenge for staff working in coronary care units.

Mark Connaughton has done an excellent job in marshalling the evidence in a readable form and presenting it in a format which is easy to follow. On the left-hand page, concise recommendations are presented. On the right-hand page there is a summary of the published evidence, together with the key references. The reader obtains an immediate perspective on what is known and not known from the evidence. If the evidence is missing, the right-hand page is blank. This sensible and usable format could serve as a model for the presentation of clinical practice guidelines in general.

The management of acute coronary syndromes is an area of rapid developments, so there are bound to be limits on the data presented. For instance, the statement “optimal strategies for managing unstable angina pectoris have not been determined and are an area of considerable current interest” has been rendered obsolete by recent trials and the development of detailed guidelines from the United States, Australian and European cardiac societies and heart associations.

Unfortunately, the excellent format of the book is not followed in section 7. Here the author breaks his own rule by presenting tables, comments on electrocardiogram interpretation and “principles” on the right hand page which are not supported by published evidence.

While there is much talk about downloading concise guidelines onto personal digital assistants (PDAs), this approach is limited by the fact that many junior medical and nursing staff do not have their own PDAs. Until the digital revolution has progressed to universal ownership of PDAs, Evidence-based coronary care is a neat solution to bringing evidence-based practice to the bedside of the patient with an acute coronary syndrome.

Peter L ThompsonCardiologist Sir Charles Gairdner Hospital, Perth, WA