Optimising acute care and secondary prevention for patients with acute coronary syndrome.

Ascertaining a patient's risk of ischaemic complications after admission with an acute coronary syndrome is an important determinant of management. The treating clinician must determine whether and how urgently to send the patient for coronary angiography and whether to select more intensive antithrombotic therapies in the acute phase, and facilitate secondary prevention strategies. Risk stratification is infrequently applied and, as a consequence, undertreatment of higher-risk patients is common. Ensuring routine application of risk stratification across hospitals may improve treatment of patients who have the most to gain from evidence-based therapies. This requires embedding standard practices into complex clinical environments, and includes the routine implementation of treatment algorithms in a permissive environment with clinical champions and support from the hospital administration. The implementation of routine systems of care defining prehospital, interhospital and individual hospital practice is challenging, but essential to minimise deficits in care.