The Clinical Care Standards in ACS: Towards an Integrated Approach to Evidence Translation in ACS Care

The evidence-base informing the management of acute coronary syndromes (ACS) is substantial and now encapsulated in numerous local and international clinical practice guidelines. These guidelines have sought to assimilate this evidence into carefully crafted and robustly debated practice recommendations representing the foundation of modern ACS care. Yet, registries of Australian and New Zealand clinical practice continue to demonstrate evidence of incomplete clinical care and sub-optimal clinical outcomes among many patients presenting with ACS. Disappointingly, sequential registries spanning nearly a decade of clinical experience continue to show significant challenges in the provision of reperfusion for ST segment elevation MI, variation in rates of angiography in non-ST elevation ACS, incomplete utilisation of secondary prevention therapies and low rates of referral to cardiac rehabilitation. This inertia in the evolution of clinical practice suggests that elements beyond physician “knowledge of the evidence” are at play in compromising the optimal adherence to guideline recommended care.