As we approach Cardiovascular Professional Care 2024, we look back at one of the standout presentations of last year’s show. The presentation explored acute management of unstable coronary disease. Delivered by Unni Krishnan, a Consultant Cardiologist at Cambridge University Hospitals NHS Trust and Royal Papworth Hospital NHS Foundation Trust, the presentation is available to watch in full below.

The presentation covers the complexities of acute coronary syndromes (ACS) and the importance of taking a more personalised and tailored approach to decision-making processes, moving beyond the conventional diagnostic tools and treatment plans.

Unni Krishnan
Consultant Cardiologist
Cambridge University Hospitals NHS Trust | Royal Papworth Hospital NHS Foundation Trust

Dr Unni Krishnan is a Consultant Interventional Cardiologist at Addenbrooke’s and Royal Papworth Hospitals, specialising in coronary angioplasty and stenting. He is the education lead for post graduate training in cardiology at Addenbrooke’s Hospital and an affiliated Assistant Professor at the School of Clinical Medicine, University of Cambridge.

Dr. Krishnan opened his presentation by introducing the pressing challenges in managing acute coronary syndromes (ACS), pointing to uninformed decision-making as the key issue to address in patient care. He began by emphasising the importance of evidence-based decision-making, stating, "When it comes to decision-making, what I always think about is what harm are we doing to the patient, and what benefit do we give to the patient?" This set the tone for a session focused on carefully considering the patient’s personal and unique clinical risks in treatment.

Throughout the presentation, Dr. Krishnan highlighted the importance of a personalised approach to managing ACS. He emphasised that each patient's unique risk profile should be the foundation of clinical decision-making, particularly when balancing the ischemic risks of ACS with the bleeding risks associated with anticoagulation therapy.

Underscoring the need to carefully weigh the potential benefit and harm of each treatment option, he urged clinicians to move away from a ‘one-size-fits-all’ approach, advocating instead for a tailored strategy that considers the patient’s comorbidities, current health status, and specific risk factors. This personalised approach is essential in ensuring that treatment plans are both effective and safe, reducing the likelihood of adverse outcomes such as stent thrombosis or excessive bleeding.

This personalised approach to decision-making begins with their diagnosis. Dr. Krishnan highlighted the value of contextualising diagnostic reading’s interpretation within the patient's overall unique clinical picture. For example, he stressed the importance of not relying solely on troponin levels as diagnostic markers, but rather incorporating a thorough assessment of clinical symptoms and patient history. This involves a detailed history-taking process where clinicians should probe beyond conventional descriptors. Such detailed and tailored questioning not only enhances the accuracy of diagnoses but also supports the implementation of personalised treatment plans. He cited studies showing that accurate history-taking remains one of the most reliable methods for diagnosing ACS, even in an era of advanced imaging technologies.

Dr. Krishnan also stressed the importance of multidisciplinary collaboration in crafting individualised treatment plans. By working closely with specialists such as haematologists, cardiologists can gain a more comprehensive understanding of a patient’s bleeding risk, particularly in complex cases involving cancer or other conditions that affect platelet counts. This collaborative approach allows for more informed decisions, ensuring that aggressive antiplatelet or anticoagulation therapy is used judiciously and safely.

Dr. Krishnan emphasized that personalised care is not just about the treatment itself, but also about the timing of interventions, the choice of medications, and the need for ongoing monitoring and adjustment of therapy based on the patient's evolving condition. Ultimately, he argues, this focus on individualised care is key to improving patient outcomes and minimizing the risks associated with ACS management.

Cardiovascular Professional Care 2023 showcased the dynamic interplay between technological innovation and human-centric care. Dr. Krishnan’s presentation on a personalised approach to patient care exemplifies the show’s commitment to addressing how best the entire MDT can collaborate and reexamine the patient pathway. As we look forward to our 2024 edition this October, we are excited to showcase new innovative practices and research that similarly paves the way for the future of surgery.