01907nas a2200169   4500000000100000008004100001100001300042700001400055700001400069700001500083245009800098250001500196300001200211490000700223520145800230020004901688       2013                            d1 aClark A.1 aBriffa T.1 aRedfern J1 aChow Clara00aImproving outcomes after acute coronary syndrome with rehabilitation and secondary prevention  a2013/08/27  a1076-810 v353 a<p>
BACKGROUND: International studies suggest almost half of all major coronary episodes annually occur in survivors of acute coronary syndrome (ACS). OBJECTIVE: A greater focus on medium- and long-term ACS management and adherence to proven therapies is essential if out-of-hospital reductions in mortality and morbidity are to be optimized. METHODS: A national panel of clinical and research opinion leaders in ACS care met for 2 days to set future priorities in health care delivery. RESULTS: Lifestyle, control of risk factors, and prescription of pharmacological therapies can improve the course of coronary heart disease (CHD) by reducing all-cause and cardiovascular mortality by 15% to 25%. All ACS patients stand to benefit from rehabilitation and systematic secondary prevention, however, underutilization and suboptimal adherence to rehabilitation and secondary prevention measures persist globally. RESULTS: A range of new initiatives in Australia and elsewhere indicate that time is ripe for change to improve the uptake of preventative treatments in patients after ACS. Key universal drivers of delivering best evidence practice for medium- to long-term care after ACS are economics and locality. CONCLUSIONS: Health-service redesign involving all stakeholders will be integral to increasing access, uptake, and adherence to lifestyle, control of risk factors, and pharmacologic therapies shown to improve cardiovascular outcomes.
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