The main hypothesis to be tested is that the use of a quality improvement programme will lead to measurable improvements in the management of care and use of evidence based treatments for patients presenting to hospital with non-ST elevation acute coronary syndromes.

Inclusion Criteria:

Patients with a good clinical history of ACS and at least one of the following:

• New or transient ST or T wave changes on the ECG consistent with acute myocardial ischaemia
• Elevation of troponin or other cardiac markers to levels indicative of myocardial necrosis according to local laboratory values

Exclusion Criteria:

• Evidence of persistent ST elevation on the ECG
• Use of early reperfusion therapy
• Patients >80 years
• Patients transferred from another hospital