Magazine article Drug Topics

New Heart Attack Guide Published on the Web

Magazine article Drug Topics

New Heart Attack Guide Published on the Web

Article excerpt

The American College of Cardiology (ACC) and the American Heart Association (AHA) have updated treatment guidelines for acute myocardial infarction (AMI). In a break with past practice, the new recommendations were first published electronically via the World Wide Web and then in printed form.

"Using the Web to do incremental updates is a great idea," said Jean Nappi, professor and vice chair, department of pharmacy practice, at the Medical University of South Carolina. "We're getting electronic changes more quickly and in more complete form than we've ever seen on paper."

The new electronic format combines both the old guidelines and newly revised material. Guidelines that have been changed or deleted are marked as a strikeout. New or revised text is shown in red. Text can be found at both the ACC Web site, www accorg, and the AHA Web site, www

"We're not in the practice of updating more often than every five years, explained Thomas Ryan, M.D., professor of medicine at the Boston University School of Medicine and chair of the joint ACC and AHA committee that created the new guidelines. "We see this as a great advance over the printed version."

Initial reaction to electronic publishing has been extremely positive, Ryan said. The new format allows practitioners to see changes at a glance rather than having to compare the old and new versions in separate publications.

Electronic publishing is also considerably cheaper for the sponsoring organizations, he noted. Lower cost is an added inducement to more frequent updates. "Instead of rewriting the full document every few years, we have committed to reviewing guidelines every two years to evaluate the need for new recommendations. In the area of heart attack man agement, the pace of new knowledge drove our decision to reevaluate available diagnostic and treatment possibilities."

Only six of the new treatment guidelines are likely to have significant impact on pharmacy. The biggest surprise, Ryan said, involves hormone replacement therapy (HRT). Women who are already receiving HRT with estrogen plus progestin at the time of an AMI can continue therapy. New data suggest that postmenopaus al women who had not begun HRT before a coronary event should not begin after an AMI.

Guidelines contin ue to recommend aspirin from day one of AMI. The recommended dosage remains at 160 to 325 mg daily through the duration of the patient's life, but other antiplatelet agents may be substituted if the patient is allergic to aspirin or unresponsive. …

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