Updated Australian guideline for acute coronary syndrome released

By Melanie Hinze

The National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand have released the updated 2025 Australian clinical guideline for diagnosing and managing acute coronary syndromes (ACS), with several implications for general practice that centre around faster and more decisive early management of potential ACS.

The guideline emphasises early identification of ACS symptoms and timely referral to appropriate hospital care. It emphasises the importance of conducting an ECG within 10 minutes of first contact in patients presenting with chest pain or suspected ACS.

GPs are encouraged to rapidly assess and escalate care for patients presenting with suspected ACS, ensuring urgent transfer to facilities equipped for definitive management.

‘GPs are often the first point of contact,’ the guideline notes, ‘and early triage and referral can significantly reduce time to treatment.’ It also advises against ruling out ACS in primary care based on clinical presentation alone; rather, it recommends urgent risk stratification.

A change in the 2025 guideline is a more aggressive target for LDL-cholesterol (LDL-C) in the post-discharge setting. The updated recommendation sets a lower LDL-C goal, which is anticipated to influence long-term secondary prevention strategies in primary care.

Patients classified as intermediate or high-risk using troponin-based clinical decision pathways should be referred to emergency care without delay. Patients with ST-elevation myocardial infarction (STEMI) require primary percutaneous coronary intervention (PCI) within 120 minutes, with fibrinolysis recommended if PCI cannot be delivered promptly.

Post-discharge, the guideline calls for continuity of care in the community, focusing on comprehensive risk factor modification, medication adherence and rehabilitation.

The guideline also addresses culturally safe care for Aboriginal and Torres Strait Islander peoples, gender-sensitive diagnosis in women and comprehensive assessment in older patients who may present with atypical symptoms.

Commenting on the importance of the guideline for GPs, Professor Mark Nelson, GP and Professor of General Practice at the University of Tasmania, Hobart, said, ‘For GPs, it is recognition of the condition and urgent referral to a centre that can manage it,’ while noting that for post-discharge management, ‘The big change here is a lower target for LDL-C.’

Professor David Brieger, Co-chair of the Guideline’s Expert Steering Group; Head of Coronary Care, Concord Repatriation General Hospital; and Professor in Medicine at Concord Clinical School, ANZAC Research Institute, The University of Sydney, said, ‘There are updates in this new Guideline that are important for GPs, from the acute approach to patients with chest pain, to updated guidance on secondary prevention strategies. These are nicely summarised in a recent article published in Heart, Lung and Circulation (https://www.heartlungcirc.org/article/S1443-9506(25)00163-5/fulltext) and I would encourage all to read them.’

The full guideline, abridged version and resources for healthcare professionals are available from the National Heart Foundation website: https://www.heartfoundation.org.au/for-professionals/acs-guideline.