Kwok, CS, Satchithananda, D and Mallen, CD (2021) Missed opportunities in coronary artery disease: reflection on practice to improve patient outcomes. Coronary Artery Disease, 33 (3). pp. 233-238. ISSN 0954-6928

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Missed opportunities refer to incidents where different actions by those involved could result in more desirable outcomes. While missed opportunities is not an established concept in coronary artery disease (CAD), they are important because CAD is common and potentially life threatening. Treatment of CAD has the potential to prevent poor patient outcomes which can have downstream consequence on resource utilization and costs for healthcare providers. The missed opportunities in CAD could be divided into those related to prevention, early detection, diagnosis and treatment. The primary prevention opportunities include management of patients with risk factors and comorbidities. In terms of diagnosis, a proportion of patients who have underlying CAD are admitted beforehand with symptoms which may be attributed to CAD. However, some may have been misdiagnosed with other conditions and are subsequently readmitted with a delayed diagnosis of ACS. In ACS, there is need for acute treatment and missed opportunities may arise from delay in diagnosis and missed reperfusion therapy. Finally, after coronary revascularization or medication management, there may be missed opportunities for patients related to secondary prevention such as smoking cessation, exercise, weight loss, attendance at cardiac rehabilitation and receipt evidenced based therapies including antihypertensives, antiplatelet and statin therapy. Our review finds that missed opportunities can become apparent if looked for in the care of patients with CAD. While the term is non-specific, it should be contextualized and described as those which are related to prevention, diagnosis and treatment. Only through reflection on clinical activities in relation to patient outcomes and the use of healthcare services can missed opportunities be identified so that better care can be delivered.

Item Type: Article
Additional Information: The final version of this accepted manuscript and all relevant information related to it, including copyrights, can be found on the publisher website at;
Uncontrolled Keywords: acute coronary syndrome, coronary artery disease, diagnosis, management, prevention
Subjects: R Medicine > RA Public aspects of medicine
R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
R Medicine > RC Internal medicine > RC666 Diseases of the circulatory (Cardiovascular) system
Divisions: Faculty of Medicine and Health Sciences > School of Medicine
Depositing User: Symplectic
Date Deposited: 27 May 2021 08:17
Last Modified: 06 Jun 2022 08:54

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