ACCREDITATION FOR THIS ACTIVITY HAS EXPIRED AND CME/CE CREDIT CAN NO LONGER BE ISSUED.  HOWEVER, LEARNERS MAY STILL VIEW THE EDUCATIONAL CONTENT.

Greetings, and welcome to this accredited CME program, Contemporary Management of NSTEMI: The Role of the Hospitalist, which was supported by an educational grant to the Hospital Quality Foundation (www.hospitalqualityfoundation.org) from AstraZeneca Pharmaceuticals.  This program brought together a diverse, multidisciplinary, and interprofessional panel of experts involved in the care of non-ST-segment-elevation myocardial infarction (NSTEMI)—interventional cardiologists, clinical cardiologists, emergency physicians, a hospital pharmacist, and—perhaps most often neglected in this setting—hospitalists.

Hospitalists may provide care to patients with NSTEMI as:

• An initial consultant to the ED, whether as the primary inpatient admitting physician, as facilitator of inter-facility transfer (which may bypass the ED), or as a ‘bridge’ to care by a cardiologist;
• As the ‘overseer’ of patients being dynamically risk-stratified in a dedicated chest pain or observation unit;
• As a consultant to another inpatient service in a patient who develops NSTEMI on the non-medical or post-operative service;
• As a manager of ‘upstream’ care, overseeing risk stratification and facilitating evidence-based, risk-driven medical therapy including antithrombotic care, analgesia, blood pressure and glycemic control, and overall stabilization; and/or
• As a manager of ‘downstream’ care, caring for the NSTEMI patient after angiography and/or intervention, maintaining evidence-based care; and/or
• As the director of the discharge and follow-up process, ensuring that evidence-based therapies are provided and that the NSTEMI patient has adequate follow-up arranged. This function enhances continuity of care and, if done well, can have a positive impact on overall care quality and 30-day readmission rates.

The hospitalist’s practice vis-à-vis NSTEMI care can also vary dramatically based on the hospital setting (small vs large, urban vs rural, teaching vs nonteaching), the extent of cardiology back-up (especially the availability of diagnostic angiography and percutaneous coronary intervention (PCI)), and the existence (or lack thereof) of protocols for care. In each of these scenarios, the hospitalist can play a key role in timely, high-quality, interdisciplinary care of the NSTEMI patient. In fact, the Society for Hospital Medicine (SHM) denotes management of ACS as a core competency for hospitalists.  We feel very strongly that the hospitalist should be involved in every institution’s protocolized response to the management of NSTEMI.

We hope you enjoy the program.

Sincerely,

Charles V. Pollack, Jr., MD, FACEP, FAHA, FACC
Program Chair