ALGORITHM FOR USE OF LIPID THERAPY POST MYOCARDIAL INFARCTION (STEMI, NSTEMI AND UNSTABLE ANGINA

)

December 2011

Adapted for local use by Johanna Hulme.0 GMMMG and Greater Manchester and Cheshire Cardiac and Stroke network – original document. The algorithm will ensure that all patients are managed via the same clinical algorithm. No. The algorithm will primarily apply to Primary care but specialists need to be aware of its existence to ensure clear communications and rationale for change to medication. Title of document Author’s name Author’s job title Dept / Service Doc. Specialists can provide information to patients. Algorithm lipid therapy post MI Page 2 of 4 GM and Cheshire Cardiac Network GMMMG . NSTEMI and Unstable angina) GMMMG and Greater Manchester and Cheshire cardiac and stroke network Various GMMMG/GM and Cheshire Cardiac and Stroke network FINAL v1. gender. Consultation History Version Final v1. Ref. 3.e. through local interpretation services.0 Date 5/10/11 10/11/11 Consultation Approved as recommendation by GMMMG Approved by Clinical Standards Board (Bolton Health Economy) NHS Bolton is the name used to refer to Bolton Primary Care Trust. 4.MMGUID03 v1. 2. This algorithm applies to all patients who have undergone treatment for the above conditions. non-English speaking patients. ethnicity or socioeconomic status who have a diagnosis as above. Has an Equality & Diversity Impact Assessment been completed? Yes 5. Clinical Standards Board November 2011 N/A June 2012 Trust Wide / Internet 1. Status Based on Signed off by Original Publication Date Last Reviewed Next review date Distribution MMGUID03 Algorithm for use of lipid therapy post myocardial infarction (STEMI.0 November 2011 Document Control Doc. who require an alternative form of communication i. older people or those with learning difficulties. The legal identity of the organisation remains unchanged. The algorithm will aim to reduce inequity across the borough. The policy will apply to all patients regardless or age.

uk/CG67  CG94 – ‘Unstable angina and NSTEMI’ http://guidance. NHS Bury (2007). NICE guidance NICE guidance is available to advise on the management of lipids in patients who have had an NSTEMI/STEMI or unstable angina but does not consider when the dose of high dose statin should be reviewed. Peter Elton.org.org.nice. Director of Public Health. Summary Atorvastatin 80mg daily for 12 months.  CG48 – ‘MI: secondary prevention’ http://guidance. See algorithm and NICE guidance CG67 for full details.0 November 2011 Background to algorithm Greater Manchester Medicines Management Group (GMMMG) have worked in collaboration with clinicians in the Greater Manchester and Cheshire Cardiac and Stroke Network to produce guidance for lipid management following a myocardial infarction.” There have been some queries from GPs with regard to QOF and the measurements used within this algorithm.nice. if no further coronary interventions within this timescale switch to simvastatin 40mg nocte (if clinically appropriate).nice. The QOF target rewards GPs for the % of CHD patients whose notes have a record of their ‘Total Cholesterol (TC) in the previous 15 months’. Algorithm lipid therapy post MI Page 3 of 4 GM and Cheshire Cardiac Network GMMMG .uk/CG48  CG67 – ‘Lipid modification’ http://guidance.MMGUID03 v1. When the TC/HDL ratio is set at an appropriate level.uk/CG94 Why measure ratio of Total Cholesterol: High-Density Lipoprotein (TC: HDL)? Evidence from the JBS2 guidelines state that: ‘the ratio of the single measure of total cholesterol (TC) to HDL cholesterol (HDL-C) is used to calculate CVD risk. as QOF incentivises ‘total cholesterol’ measures alone. GPs can still obtain maximum QoF points (and hence payment) it will be unusual for someone who reaches their TC/HDL ratio target not to reach their QOF total cholesterol target which is 25% higher than that recommended by JBS2 guidelines.org. Information above was taken from a report written by Dr.

0 November 2011 ALGORITHM FOR USE OF Lipid Therapy Post Myocardial Infarction (STEMI. NSTEMI & UNSTABLE ANGINA) Patient with STEMI.MMGUID03 v1. NSTEMI & Unstable Angina Commence Atorvastatin 80 mg daily Check lipid level at 6 months to assess compliance TC:HDL ratio still decreased by > 25% compared to pre-treatment levels (To confirm compliance) YES NO Continue Atorvastatin 80mg & check lipid level at 12 months TC:HDL ratio decreased by > 25% compared to pre-treatment levels YES and TC: HDL ratio <3. discuss ways to improve compliance TC: HDL ratio >4.0 Continue Simvastatin 40mg Consider restarting Atorvastatin 80mg Algorithm lipid therapy post MI Page 4 of 4 TC: HDL ratio <4.5 NO Change to Simvastatin 40mg Continue Atorvastatin 80mg Check lipid level at 15 months Discuss compliance with patient – if non-compliance confirmed.0 If compliant yet have genuine multiple statin intolerance seek advice from a lipid clinic GM and Cheshire Cardiac Network GMMMG .