SIGN 148: Acute coronary syndrome (ACS) provides recommendations for the management of patients with ACS within the first 12 hours and up to hospital discharge. It includes sections on presentation, assessment and diagnosis, initial management, reperfusion therapy, risk stratification and non-invasive testing, invasive investigation and revascularisation, early pharmacological intervention and treatment of hypoxia and cardiogenic shock.

Coronary heart disease (CHD) is the single biggest cause of death in Scotland as well as being a major cause of premature mortality (death in people aged under 75). In Scotland in 2012, CHD accounted for 16% of all deaths in men and 11% in women.

Myocardial infarction, which together with unstable angina comprise ACS, accounted for more than half of all deaths from CHD in Scotland in 2013/14, with a third of these being in people under 75 years of age (44% in men and 21% in women).

SIGN 148 replaces SIGN 93: Acute coronary syndromes and includes new recommendations on high-sensitivity troponin assays, the choice and duration of dual antiplatelet therapy and surgical management options.

This is the second of six coronary heart disease guidelines being updated by SIGN over the course of 2016–2018:

SIGN 147: Management of chronic heart failure

SIGN 147: Management of chronic heart failure provides evidence-based recommendations and best practice guidance on the management of patients with chronic heart failure. It includes recommendations on diagnosis, lifestyle modification, pharmacological and interventional therapies, organisational planning and palliative care.

it is estimated that around 2.3 million people in the United Kingdom have coronary heart disease, 500,000 of whom have heart failure. In Scotland the estimated prevalence of heart failure for all ages is 1.44% in men and 0.82% in women. This rises to 8.72% and 5.97% for men and women over the
age of 75.

SIGN 147 replaces SIGN 95: Management of chronic heart failure and includes new recommendations on pharmacological therapies, cardiac resynchronisation therapy and implantable cardioverter defibrillators.