Non- ST Elevation Myocardial Infarction Treatment in UK (Coursework Sample)

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Review of Non- ST elevation Myocardial Infarction Treatment in the United Kingdom
Acute ST-Elevation myocardial infarction, acute non-ST-Elevation myocardial infarction (NSTEMI), or unstable angina (UA) are the three major manifestations of acute coronary syndromes (ACS). The first step towards caring for patients with ACS is early recognition since therapy is highly effective when carried out promptly upon hospital presentation. For the patients showing up at the emergency department with suspicions of ACS due to chest pains, the diagnosis could be confirmed by serum cardiac biomarker elevation and electrocardiogram. However, it is imperative to note that during this process, the healthcare experts rely heavily on the history in order to diagnose unstable angina. Upon diagnosis of an acute NSTEMI or UA, the patient’s acute management would follow simultaneous achievement of multiple goals.
Epidemiologically, Non-ST-elevation myocardial infarction (NSTEMI) is one of the leading causes of emergency admissions in Europe hospitals and accounts for more than 50,000 National Health Service (NHS) hospitalisations every year (Dondo et al. 1). The number of deaths caused by NSTEMI is not only higher but also worse as compared to the mortality rates of ST-elevation myocardial infarction (STEMI), and its incidence is increasing with multi-morbid and ageing population. Nevertheless, the clinical outcomes from NSTEMI might be enhanced by using guideline-indicated treatments such as invasive coronary procedures and evidence-based pharmacological therapies. Whereas hospitals are the main institutions for managing acute myocardial infarction, for most nations, especially the United Kingdom, the local contracting of specialist services such as acute cardiac care, ambulances, and emergency departments determine the treatments. For the English NHS, this is the duty of the 211 Clinical Commissioning Groups (CCGs) working in partnership with healthcare Institutions through the support of national Institute for Health and Care Excellence for NSTEMI commissioning (Dondo et al. 1).
The earlier research conducted by Dondo et al. (2016) unveiled evidence for variation between and within Sweden and the United Kingdom in care and one-month mortality from acute myocardial infarction. A similar study also showed that a great percentage of patients suffering from acute myocardial infarction do not receive at least one-guideline indicated treatment, an occurrence that was significantly linked to the cardiovascular mortalities. Just like in the United Kingdom and Sweden, Gibler (2018) confirms that the incidence of the disease burden is also alarming in the United States. According to the EMCREG-International president, close to 250,000 patients from various hospitals in the United States are battling STEMI every year in the country (Mamas, et al. 5). The American Heart Association and the American College of Cardiology Foundation updated the guidelines for managing STEMI in 2013. A first class recommendation for regional systems of treatment of STEMI suggested “all communities should create and maintain a regional system of STEMI care that includes assessment and continuous quality improvement of emergency medical services and hospital-based activities” (Gibler 116).
Certainly, to overcome some of the barriers that could hinder the efficient, coordinated STEMI system and to optimize clinical outcomes, the regional leaders have to come together to address such issues and implement best practices. It has also been established that competition in regions with multiple physician groups and hospitals might avert a coordinated effort of achieving reperfusion in a regionally efficient way; something that might compel the providers of Emergency Management System (EMS) to navigate multifaceted referral networks (Switaj, Christensen, and Brewer 232). Development of a full-bodied STEMI treatment system needs investment in personnel and equipment for both hospitals and prehistoric agencies. However, it is also important to note that prehistoric agencies are defied by escalating demand; thus, the need for a consistent training and education and ongoing equipment maintenance programs.
Primary Prevention
The guidelines spelled out by the American Heart Association (AHA) continue to stress the benefit of primary prevention as far as the management and care of acute coronary syndrome (ACS) is concerned (Switaj, Christensen, and Brewer 233). The main focus of primary prevention is to decrease the risk factors for coronary heart diseases including hypercholesterolemia, smoking, hypertension, family history of a coronary artery disease, and not limited to diabetes mellitus. Regarding primary management, family doctors ought to continue educating their patients on the risk factors, symptoms, as well as the clinical diagnosis of ACS. Older patients, women, people with diabetes, as well as postoperative patients, also ought to be cognisant of developing presentation and atypical symptoms for ACS. Patients who are at risk should be educated and advised regularly to seek medical attention as soon as they experience any sign or symptom of the disease.
At the individual level, persons who are likely to develop this disease should be advised to take non-enteric coated aspirin as soon as they recognise the first symptom of ACS unless they have shown a past record of aspirin sensitivity. At the community level, local areas ought to come up with and maintain emergency medical service systems, which support STEMI care. The initial treatment need to include a comprehensive assessment of risk factors for coronary artery disease and clinical symptoms alongside a 12-lead electrocardiography (Switaj, Christensen, and Brewer 234). Health care experts also need to be aware that electrocardiographic results that might point to myocardial infarction include the QRS complex, changes in the PR segment and the ST segment. A section of the initial assessment also entails getting cardiac biomarkers including troponin. Primary percutaneous coronary intervention (PCI) is the most recommended method for reperfusion; hence all efforts need to be made to transport an individual with a suspected case of STEMI to a hospital that can treat PCI. In an event that there is no PCI-capable hospital in half an hour travel time, medical management needs to be carried out in the nearest emergency department. The objective of medical management is to give fibrinolytic therapy within half an hour of the initial medical contact.
Prehospital Electrocardiogram Transmission
Prehospital electrocardiogram (ECG) transmission is an important component of any regional STEMI system. people suffering from anterior wall STEMI and have been given percutaneous coronary intervention (PCI) have been evaluated and categorised retrospectively based on pre-arrival STEMI notification and mode of transport. The research conducted by Gibler (2018) showed that the patients who were transported through EMS with STEMI notification indicated the shortest time for door-to-balloon (DTB). Besides, this category had a reduced size of infarct as compared to their counterparts who were transported without STEMI notification (Gibler 120). The impact of wireless transmission of prehospital ECGs on reperfusion times and STEMI recognition has been evaluated. Studies have shown that individuals with prehospital ECGs experienced an average DTB time of 66 minutes and a mean time of transport to the angioplasty suite of 43 minutes as opposed to the patients with STEMI who never received prehospital ECGs who had took 49, and 79 minutes respectively (Gibler 120). This assertion confirms that the population in the study who had concomitant cardiac catheterization laboratory (CCL) activation and prehospital STEMI identification showed a statistically significant reduction in mean time of transport to the DTB time and the angioplasty suite, which were 58 and 33 minutes respectively.
Electrocardiogram (ECG)
Many aspects limit the capacity of the ECG to detect transient ischemia or acute myocardial infarction. The temporal variations in changes in the ST segment insinuate that an isolated, single recording might not positively respond to the diagnostic changes. It is also imperative to realise that there is a high probability for the non-Q-wave infarcts to show insignificant, non-specific changes in ECG that do not meet the diagnostic creteria (Lopes et al. 1513). Interpreting small changes in ECG also relies heavily on the probability of pre-test of the patients suffering from ischemic heart disease. With large infarcts transmural, conduction defects combined with multiple events might obscure the possible diagnostic changes. Even so, given the 12 conventional ECG leads’ position, posterior infarcts usually give rise to ECG changes which are often missed and difficult to interpret. The location and severity of ischaemia grounded in the position of assessing electrodes, thus limit the ECG sensitivity in detecting ischaemia (Lopes et al. 1518). Researchers believe that using retrospective analysis among the patients who have shown infarction during autopsy is the crudest way of measuring the effectiveness of ECG in detecting acute myocardial infarction. In such experimental cases, the evidence of ECG on infarction could be found in half of the cases or more. Nevertheless, it has been noted that the sample population used in such a study die of severe extensive disease that might not necessarily reflect the capability of ECG in detecting less severe ischemia. Conduction defects combined with multiple infarctions also usually obscure the Q-waves and create non-diagnostic ECG changes.
In an acute s...