The Living Guidelines: UA/NSTEMI Recommendations for Medical Regimen and Use of Medications Suggest Revisions to the CLASS I Guidelines

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Class I Guidelines

 * 1) Medications required in the hospital to control ischemia should be continued after hospital discharge in patients with UA / NSTEMI who do not undergo coronary revascularization, patients with unsuccessful revascularization, and patients with recurrent symptoms after revascularization. Upward or downward titration of the doses may be required. (Level of Evidence: C)
 * 2) All post UA / NSTEMI patients should be given sublingual or spray NTG and instructed in its use. (Level of Evidence: C)
 * 3) Before hospital discharge, patients with UA / NSTEMI should be informed about symptoms of worsening myocardial ischemia and MI and should be instructed in how and when to seek emergency care and assistance if such symptoms occur. (Level of Evidence: C)
 * 4) Before hospital discharge, post UA / NSTEMI patients and/or designated responsible caregivers should be provided with supportable, easily understood, and culturally sensitive instructions with respect to medication type, purpose, dose, frequency, and pertinent side effects. (Level of Evidence: C)
 * 5) In post UA / NSTEMI patients, anginal discomfort lasting more than 2 or 3 min should prompt the patient to discontinue physical activity or remove himself or herself from any stressful event. If pain does not subside immediately, the patient should be instructed to take 1 dose of NTG sublingually. If the chest discomfort/pain is unimproved or worsening 5 min after 1 NTG dose has been taken, it is recommended that the patient or a family member/friend call 911 immediately to access EMS. While activating EMS access, additional NTG (at 5-min intervals 2 times) may be taken while lying down or sitting. (Level of Evidence: C)
 * 6) If the pattern or severity of anginal symptoms changes, which suggests worsening myocardial ischemia (e.g., pain is more frequent or severe or is precipitated by less effort or now occurs at rest), the patient should contact his or her physician without delay to assess the need for additional treatment or testing. (Level of Evidence: C)