Adherence to guideline recommendations for coronary angiography in a poor South-East Asian setting: Impact on short- and medium-term clinical outcomes

Abstract

In South-East Asian populations and particularly in Indonesia, access to coronary angiography (CAG) is limited. We aimed to assess the adherence for undergoing CAG for indicated patients, according to the guideline recommendations. We then examined whether this adherence would have an impact on patients’ short- and medium-term mortality and morbidity. We consecutively enrolled 474 patients with acute and stable coronary artery disease who had indication for CAG at Makassar Cardiac Center, Indonesia from February 2013 to December 2014. We found that adherence to CAG recommendation in poor South-East Asian setting is low. Of 474 recommended patients, only 273 (57.6%) underwent the procedure. Factors for not undergoing CAG were: older age, female gender, low educational and socio-economic status, and insurance type. While reasons for patients refusing CAG and subsequent intervention included fear, symptoms reduction, and lack of trust concerning the procedure benefit. During follow-up (median 19 (IQR 6–39.3) months), 155 (32.7%) patients died, and 259 (54.6%) experienced at least one adverse event. Adherence to CAG recommendation was associated with a significantly lower short- and medium-term mortality, independent of revascularization and other potential confounders. In sub-group analysis, adhered patients “with revascularization” had significantly better outcomes compared to the “non-revascularization” and “not adhere” groups.

Predictors of Nonadherence to Planned Coronary Angiography: A Retrospective Analysis

“…When the CAG's benefits far outweigh its known risks, an appointment is scheduled after gaining consent from patients or their families 5 . The percentage of patients going through with their scheduled CAG reported in previous studies is rather low (57.6-59%) 6,7 . In other words, the reported incidence of the refusal of scheduled CAG on the part of patients is nearly half of the total scheduled cases 6,7 .…”

CYP2A6 gene polymorphism and severity of coronary atherosclerosis in Indonesian male smokers: A pilot study

“…Our previous study showed that a total of 62.3% (out of 477) CAD patients were smokers. [ 14 ] In this current study, all subjects were active smokers for at least 10 years with regular smoking of ≥ 10 cigarettes per day. Although several prevention attempts have been regulated, cigarette smoking is still the number 1 cause of preventable death in developing countries.…”

Clinical Cardiology in South East Asia: Indonesian Lessons from the Present towards Improvement

“…In addition to educational and financial level, the opinions of family and relatives, religious beliefs, social values, local culture, and fear of the hospital and medical interventions have always been influential factors, meaning that patients often end up with reluctant or rejection to recommended treatment. In our previous study, participants with lower educational attainment and lower-income was the majority of ACS patients who chose not to undergo CAG and subsequent intervention [ 48 ]. Inversely, a cross-sectional study by Peiris et al in 2020, showed that higher educational level and being on employment associated with a lower risk of CVDs in most LMICs [ 49 ].…”