London Cardiovascular Project

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Non-ST elevation acute coronary syndrome (NSTEACS)


The sudden onset or rapid worsening of cardiac chest pain due to shortage of blood supply to part of the heart is called acute coronary syndrome (ACS).

This can be subdivided into conditions where an artery is completely blocked (an ST elevation myocardial infarction, or STEMI) and those where it is incompletely or intermittently blocked, a non-ST elevation acute coronary syndrome (NSTEACS).

Clinical evidence shows that after 12 months, some of these patients have the same mortality rate as patients who have had a full STEMI.

'High risk' NSTEACS patients that have early access to diagnostic angiography and appropriate treatment have improved long-term mortality outcomes.


The London Cardiac Networks are responsible for implementation with the North East London Cardiac and Stroke Network leading the collaboration.

Project aims

Ensure that high risk heart attack patients (NSTEACS) are risk stratified at A&E and have access to angiogram and angioplasty within 24 hours


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  • Patients with suspected NSTEACS should be diagnosed in an emergency department and risk assessed.
  • High risk NSTEACS patients should follow a pathway that guarantees treatment within 24 hours. A transfer to a NSTEACS centre may be required for some patients.
  • High risk patients should receive immediate, evidence-based medical therapy and have access to an angiogram and PCI.

Implementation update

  • NSTEACS site assessments are complete for all Networks.
  • Early implementer feeder sites have completed their ED training and have now gone live in all Networks.
  • The Heart Hospital, Royal Free, Hammersmith, Royal Brompton, Harefield, Northwick Park, Barts and the London, King's College, St Thomas' and St George's have all been assessed as NSTEACS centres.
  • Sites still to go live include Ealing (January 2012), Central Middlesex (January 2012), Croydon University Hospital (February 2012), Princess Royal University Hospital (March 2012) and Whipps Cross (March 2012).
  • Full roll out across all feeder sites is on target for completion March 2012.
The NSTEACS work aims to improve equity and quality of service across London and avoid two hospital admissions for patients.

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College of Emergency Medicine - Presentation 21st June

Definition of high risk NSTEACS - Pan-London agreement

Training slide deck - Customisable template for use in A&E training

Local implementation

South London


One page flier - NSTEACS work

Background documents

Model of care (summary)
Model of care (detailed)
Patient perspective
Responses to engagement
Case for change
Co-dependencies framework
Financial analysis

More on the
patient perspective