Nurse specialist-led management of acute coronary syndromes

Khaled Alfakih, Martin Melville, Jacqui Nainby, Jamie Waterall, Kevin Walters, John Walsh, Alun Harcombe*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)


The management of acute coronary syndromes (ACS) has changed greatly over recent years. Trial evidence encouraged clinicians to consider early invasive management in high-risk patients and this has created a large clinical burden. We instituted a comprehensive system of nurse-led diagnosis and management of ACS. In-patients are seen by a cardiac outreach nursing team and depending on their risk profile may be managed in a designated acute cardiac unit (ACU) by cardiologists. We also piloted an 'ACS clinic' where patients with higher risk are seen within two weeks of discharge. We conducted audits to assess the impact of these new services. A total of 158 consecutive patients from ACU with unstable angina or non-ST elevation myocardial infarction (NSTEMI) were identified. The in-patient coronary angiography rate was 48%, percutaneous coronary intervention (PCI) rate 15% and coronary artery bypass graft (CABG) rate 4%. The six-month re-admission rate was 28.5%, of whom 44.4% were within one month of discharge. In-patient coronary angiography almost halved the rate of re-admission (20.0% vs. 36.6%; p=0.026). We also audited the first 12 months of the ACS clinic. The six-month re-admission rate was 14.2%, a significant reduction compared with the first audit (p=0.0002). In conclusion, the strategy of nurse-led identification and follow-up of ACS patients promotes effective use of resources and reduces re-admissions.

Original languageEnglish
Pages (from-to)132-134
Number of pages3
JournalBritish Journal of Cardiology
Issue number3
Publication statusPublished - May 2009
Externally publishedYes


  • Acute coronary syndromes
  • Audit
  • Invasive management


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