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At the heart of general practice since 1960

New risk tool to help ACS patients

By Lilian Anekwe

A tool to predict six-month risk of death or heart attack in patients with acute coronary syndromes will help GPs direct treatment more appropriately, say researchers.

In a multinational study of more than 43,000 patients, researchers identified nine factors which independently predicted death or myocardial infarction in the six months

after presentation.

An online calculator developed from the data will enable clinicians to identify patients who would most benefit from treatment.

Guidelines from NICE suggest interventional and pharmacological therapies, such as reperfusion, should be targeted to people at higher risk but patients are often assessed on the basis of one or two factors alone.

As well as more accurate risk assessment, the tool could aid the handover from secondary to primary care, GPs said.

Study leader Professor Keith Fox, professor of cardiology at the University of Edinburgh, said: 'Patients with high-risk features are relatively straightforward to identify, but

most patients lie in the intermediate range and risk is less obvious.

'This intermediate range encompasses up to 10-fold differences in the risk of death.'

He said the model should be used to 'identify which patients need interventional measures, and serves as a guide for primary care'.

Dr Paramjit Gill, a senior clinical lecturer in the department of primary health and general practice at the University of Birmingham, said: 'It is a hospital-based model, but it does have potential for use identifying at-risk patients in primary care.'

Dr Gill added that in his practice in Birmingham the tool would be useful for facilitating 'a shared protocol approach

to care'.

But Dr Peter Brindle, a NICE adviser on cardiovascular disease risk and a GP in Bristol, said GPs using the tool would need more information about different management strategies. 'With medical interventions we need to know what the point of it is, and if it going to be useful.

'What we do not need are

interventions that don't appear to be applicable to primary care.'

The study, published online in the BMJ, used data from

patients in the global registry

of acute coronary events (www.outcomes.org/grace).

lanekwe@cmpmedica.com

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