The guidelines' key recommendations on prevention include:
- Everyone over 40 years old in Scotland should be assessed for risk of CHD (and stroke) at least every five years. However, the guidelines note that NHSScotland is developing a new risk assessment tool, (derived from Scottish data) that will include family history, detailed smoking habit, and social deprivation as additional risk factors.
- Lifestyle advice, should be given to everyone at such assessments.
- 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.
The guidelines' key recommendations on treatment include:
- 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 (a small porous mesh) 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 (heart X-rays) and be evaluated for possible angioplasty and stenting.
- 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.
The full guidelines can be found on the SIGN website.