Acute coronary syndromes (ACS) clinical guidelines

Guidelines for acute coronary syndromes for clinical care of patients presenting with suspected or confirmed ACS.

In 2020-21, 92,400 Australians were admitted to hospital because of an acute coronary syndrome (ACS). In 2017-18, it was predicted that ACS events in Australia would cost governments alone $1.93 billion for the financial year.

These clinical guidelines for acute coronary syndromes seek to provide help regarding the clinical care of patients presenting with suspected or confirmed ACS. They were published in 2016 by the National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand.

Practical guidance for ACS care in Australia was derived from the extensive evidence base regarding the clinical effectiveness of different interventions and treatment strategies. In addition to reviews of published trials and systematic reviews, guideline content was informed by other international clinical guidelines and local clinical expertise. 

Who can use these guidelines? 

The clinical guidelines are for practicing health care professionals across all disciplines. 

What's in the guidelines? 

• New recommendations and key practice points incorporating new evidence that has been graded on the certainty of evidence and the likely absolute benefit versus harm. 

• A focus on key components of the management associated with improved clinical outcomes for patients with chest pain or ACS.  

• Advice on the standardised assessment and management of patients with suspected ACS, including the implementation of clinical assessment pathways and subsequent functional and anatomical testing.  

• Guidance on the diagnosis and risk stratification of ACS, provision of acute reperfusion therapy and immediate post-fibrinolysis care for patients with ST segment elevation myocardial infarction 

• Risk stratification informing the use of routine versus selective invasive management for patients with non-ST segment elevation ACS 

• Administration of antithrombotic therapies in the acute setting and consideration affecting their long term use 

• Guidance on the implementation of an individualised secondary prevention plan that includes both pharmacotherapies and cardiac rehabilitation  

• The guidelines provide new assessment protocols and algorithms, including three for suspected ACS using point-of-care assay, sensitive lab-based assay and highly sensitive lab-based assay, along with treatment algorithm for ST-elevation myocardial infarction (STEMI), as well as decision-making and timing considerations in reperfusion for STEMI. 

Who has endorsed the guidelines? 

• The Australasian College for Emergency Medicine (ACEM) 

• The Australian Cardiovascular Health and Rehabilitation Association (ACRA) 

• The Royal College of Pathologists of Australasia (RCPA) 

• The Internal Medicine Society of Australia and New Zealand (IMSANZ) 

• The Australasian Cardiovascular Nursing College (ACNC) 

• The Council of Remote Area Nurses of Australia (CRANA) 

• The Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) 

• The Australian Commission on Safety and Quality in Health Care (ACSQHC).  

How were the guidelines developed? 

Development of these guidelines is based on evidence by the National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand. 

A working group consisting of members of the medical community – who are leading experts in their respective fields in Australia and overseas – wrote the guidelines. Their approach to the development and consultation was to ensure appropriate stakeholder representation and engagement in the writing process. 

The development of these recommendations used GRADE methodology, which assesses the certainty of the evidence and the strength of recommendations, alongside the National Health and Medical Research Council (NHMRC) level of evidence scheme.

Further information about the development process is available in the guidelines themselves.    

ACS Guideline Presentations

In 2016, the National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand released the Australian Clinical Guidelines for the Management of Acute Coronary Syndromes 2016.

Full presentation and summary presentation of the guidelines are available below for download and can be used to present to your colleagues or work departments.