Person—clinical evidence status (acute coronary syndrome related medical history), yes/no code N

Guide for use:

CODE 1 Yes

Use this code where there is objective evidence to support a history of an acute coronary syndrome related medical condition.

CODE 2 No

Use this code where the history is not supported by objective evidence.

Objective evidence for acute coronary syndrome related medical conditions are classified as:

Chronic lung disease:

Diagnosis supported by current use of chronic lung disease pharmacological therapy (e.g. inhalers, theophylline, aminophylline, or steroids), or a forced expiratory volume in 1 second (FEV1) less than 80% predicted FEV1/forced vital capacity (FVC) less than 0.7 (post bronchodilator). Respiratory failure partial pressure of oxygen (PaO2) less than 60 mmHg (8kPa), or partial pressure of carbon dioxide (PaCO2) greater than 50 mmHg (6.7 kPa).

Heart failure:

Current symptoms of heart failure (typically shortness of breath or fatigue), either at rest or during exercise and/or signs of pulmonary or peripheral congestion and objective evidence of cardiac dysfunction at rest. The diagnosis is derived from and substantiated by clinical documentation from testing according to current practices.

Stroke:

Diagnosis for ischaemic: non-haemorrhagic cerebral infarction or haemorrhagic: intracerebral haemorrhage supported by cerebral imaging (CT or MRI).

Peripheral arterial disease:

• Peripheral artery disease: diagnosis is derived from and substantiated by clinical documentation for a person with a history of either chronic or acute occlusion or narrowing of the arterial lumen in the aorta or extremities.
• Aortic aneurysm: diagnosis of aneurysmal dilatation of the aorta (thoracic and or abdominal) supported and substantiated by appropriate documentation of objective testing.
• Renal artery stenosis: diagnosis of functional stenosis of one or both renal arteries is present and is supported and substantiated by appropriate documentation of objective testing.

Sleep apnoea:

Diagnosis derived from and substantiated by clinical documentation of sleep apnoea syndrome (SAS). SAS has been diagnosed from the results of a sleep study.

Other vascular conditions:

• Atrial fibrillation: diagnosis supported by electrocardiogram findings.
• Other cardiac arrhythmias and conductive disorders: diagnosis supported by electrocardiogram findings.
• Left ventricular hypertrophy: diagnosis supported by echocardiograph evidence.

Comments:

Heart failure:

Chronic heart failure is a complex clinical syndrome with typical symptoms (e.g. shortness of breath, fatigue) that can occur at rest or on effort, and is characterised by objective evidence of an underlying structural abnormality of cardiac dysfunction that impairs the ability of the ventricle to fill with or eject blood (particularly during physical activity).

The most widely available investigation for documenting left ventricular dysfunction is the transthoracic echocardiogram (TTE).
Other modalities include:

• transoesophageal echocardiography (TOE)
• gated radionuclide angiocardiography
• angiographic left ventriculography

In the absence of any adjunctive laboratory tests, evidence of supportive clinical signs of ventricular dysfunction. These include:

• cardiac auscultation (S3, cardiac murmurs),
• cardiomegaly,
• elevated jugular venous pressure (JVP),
• chest X-ray evidence of pulmonary congestion