The updated advice includes LDL-C targets, DOACs and antiplatelet therapy, and evidence of the benefits of semaglutide.
More detailed advice on managing patients with acute coronary syndromes –including advice on medications, vaccinations and lifestyle interventions – has been published by the Heart Foundation and the Cardiac Society of Australia and New Zealand.
Heart Foundation chief medical advisor Professor Garry Jennings said the guideline included new and updated recommendations on antiplatelet therapy (DAPT), with an emphasis on tailoring dual antiplatelet therapy duration based on a patient’s ischaemic and bleeding risks.
“It also provides a strategy for people taking direct oral anticoagulants (DOACs) with atrial fibrillation, where the step-down strategy from combined DOAC and DAPT (triple therapy) is determined by the person’s ischaemic risk.
“A new recommended treatment target for low-density lipoprotein cholesterol (LDL-C) of <1.4mmol/L, with at least a 50% reduction from baseline, brings Australia in line with international guidance and reinforces the benefit of achieving the lowest possible levels.
“The guideline also highlights the role of emerging post-ACS therapies including GLP-1 analogues, PCSK9 inhibitors and colchicine.”
Professor Jennings said new practice points also addressed the needs of women, older adults, First Nations peoples and people living in regional and remote areas.
The guideline also includes new evidence showing that semaglutide has cardiovascular benefits in people who are overweight or obese, even without diabetes, Professor Jennings said.
“We updated Australian ACS guideline to include this emerging evidence, particularly findings from the SELECT trial, which showed that once weekly semaglutide significantly reduced the risk of cardiovascular death, non-fatal myocardial infarction, and non-fatal stroke in adults with established CVD.
“This points to a potential role for semaglutide as an adjunct therapy for secondary prevention in people with ACS who meet criteria for overweight or obesity.”
Professor Jennings said key practice changes have also been included, such as broader recognition of ECG patterns of acute coronary occlusion myocardial infarction (ACOMI), integration of hs-cTn testing into clinical decisions pathways and selective use of intravascular imaging in NSTEACS.
“In addition, the guideline provides updated advice on the timing of P2Y12 inhibitors, sets stricter LDL-C targets, and recommends PCSK9 inhibitor use to support more tailored, evidence-based care for the secondary prevention of ACS.”
The guideline also gives more detailed advice on medications after discharge, including antiplatelet therapy, anticoagulant therapy, lipid-modifying therapy, beta blockers, renin-angiotensin antagonist therapies and colchicine.
After discharge from hospital, patients should have follow-up appointments with their GP, the treating team and cardiac rehabilitation, the authors said.
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“Two-way communication between the discharging hospital and the person’s general practitioner is critical to support their ongoing care. Similarly, encourage people with ACS to establish/maintain regular contact with their general practitioner for ongoing follow-up.
“Initiate a general practitioner management plan or team care arrangement to assist in the management of comorbidities. This is particularly important for older adults with geriatric syndromes including frailty, impaired cognitive function and polypharmacy.”
Beta blockers are recommended in people with ACS and left ventricular dysfunction, as they reduce the risk of myocardial infarction.
“However, they produce no reduction in all-cause death or MI in people with preserved ejection fraction undergoing early angiography.”
But the authors urged caution when initiating beta blockers in people with myocardial infarction and cardiogenic shock risk factors, as they have an increased risk of dying earlier.
There’s also no benefit in continuing beta blockers for more than 12 months in people with preserved ejection fraction, they said.
“And in asymptomatic people who have had an episode of UA (i.e. without MI) and with normal LVEF, there is little evidence for protection against MACE from beta blocker therapy in the absence of other indications.”
Clinicians can also discuss practical strategies to optimise patients’ adherence, such as setting up daily alerts and taking fixed combination medicines, the authors said.
The guideline now includes more detailed advice on post-discharge care, recommending that all patients with acute coronary syndrome be given advice on lifestyle changes such as healthy eating, physical activity, not smoking, limiting alcohol intake and caring for their mental health.
The authors said smokers should be referred for behavioural intervention such as cognitive behaviour therapy or cessation counselling program and offered pharmacotherapy where appropriate, such as nicotine replacement therapies, varenicline or bupropion.
Patients should also be screened for depression and other mental health conditions and referred for mental health support if needed.
“People with ACS commonly experience feelings of low mood, sadness, guilt, worry and anger,” the authors said.
The guideline recommends that patients with ACS be vaccinated against influenza, RSV, pneumococcal disease and covid. “Vaccination against influenza can reduce the risk of further cardiac complications in people with ACS or cardiovascular disease.”
Meanwhile, the American College of Cardiology released a new expert consensus statement on vaccinations in cardiovascular care, also recommending that patients with heart disease receive vaccinations against influenza, RSV, covid and pneumococcal, as well as shingles.
The ACOC also offers strategies to address vaccine hesitancy, and suggested answers to common questions from patients.
The American College of Obstetricians and Gynecologists also released updated guidelines for vaccination in obstetrics care, reinforcing their recommendation that women should have the RSV, influenza and covid vaccinations during pregnancy.
Australian clinical guideline for diagnosing and managing acute coronary syndromes 2025
