Challenges and solutions in medically managed ACS in the Asia-Pacific region: Expert recommendations from the Asia-Pacific ACS Medical Management Working Group

Huo, Yong; Thompson, Peter L.; Buddhari, Wacin; Ge, Junbo; Harding, Scott; Letchuman, Ramanathan; Reyes, Eugenio B.; Santoso, Anwar; Tam, Li-Wah; Vijayaraghavan, G; Yeh, Hung‐I

doi:10.1016/j.ijcard.2014.11.195

Cited by 17 publications

(20 citation statements)

References 102 publications

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“…Although these points are based on experiences of just one hospital in a developing country, previous literature appears to reflect similar problems across the Asia-Pacific region. 19 Such is the lack of digital patient records, it is very challenging to scrupulously analyse the key features of these services that are underperforming.…”

Section: Discussionmentioning

confidence: 99%

“…Whilst it's highly encouraging that Nepal has the facility to perform these advanced healthcare procedures, like many Asian developing countries, patient affordability is a major barrier to accessing them. 19 As Nepal's economy grows, the cost of interventions for ACS should become less expensive and more widely available to its population. It would hence be advisable for SGNHC to lobby for increased government financial contributions to ACS services given the burden that this particular disease is putting on their healthcare system.…”

Section: Patient Factorsmentioning

confidence: 99%

“…Because of this, patients tend to choose personal or public transport because it is relatively quick compared to taking an ambulance -especially if they live outside of the city. Often patients from rural Nepal commute for hours if not days to access a suitable hospital and it is a very common reason for delayed presentation and subsequent poorer outcomes in ACS patients 19 . It should be a public health priority to have a well-publicised emergency phone number that triggers an ambulance from the local area to collect a patient promptly and efficiently.…”

Section: The Final Area Of Stark Contrast Between the Acs Services Inmentioning

confidence: 99%

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How do the cardiology services for patients presenting with acute coronary syndromes compare between developing and developed countries?

Mears

2019

Nepalese Heart J.

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Background and Aims: Acute Coronary Syndromes (ACS) represent a significant challenge for healthcare systems worldwide, however there is a vast disparity between developed and developing countries in terms of their management and subsequent patient outcomes. The aim of this reflective report was to explore the services provided for ACS patients in the developing country Nepal and compare them to the highly developed United Kingdom. This was with a view to summarise the priorities for Nepal going forward in addressing this major public health challenge and improving their ACS patient outcomes.Methods: This reflective report was constructed following an elective placement at the Shahid Gangalal National Heart Centre in Kathmandu, Nepal. It involved collecting numerous ACS patient case studies from the United Kingdom (UK) and Nepal and reflecting on their clinical experiences using the Gibbs Reflective Cycle.Reflective Summary: The treatment strategies for ACS are very similar in both countries, however in Nepal it is more difficult to efficiently transport patients into hospital and the population is less aware of the symptoms of ACS, thus contributing to delayed presentations and poorer outcomes. Furthermore, the provision of non-emergency healthcare, collection of patient data and general hospital resources were understandably deficient in comparison to the UK given the difference in financial status.Discussion: In order to address the rising incidence of ACS, Nepal should prioritise investment in the hospital facilities provided for these patients, including suitably equipped emergency transport and cardiac catheterisation laboratories. In addition, they should work towards an electronic patient database and more established non-emergency healthcare services. Perhaps most importantly is the need for improved health promotion about the risk factors for ACS and the signs of a heart attack.

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Section: Discussionmentioning

confidence: 99%

Section: Patient Factorsmentioning

confidence: 99%

Section: The Final Area Of Stark Contrast Between the Acs Services Inmentioning

confidence: 99%

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How do the cardiology services for patients presenting with acute coronary syndromes compare between developing and developed countries?

Mears

2019

Nepalese Heart J.

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“…В каче стве причины выбора консервативной стратегии ведения пациентов в ряде исследований обозначены и такие факто ры, как отсутствие возможности проведения ангиографии, нежелание пациента (реже врача), занятость рентгенопе рационной, отсутствие расходных материалов и т. д. [16].…”

Section: обзоры §unclassified

“…В исследованиях Achar S. A., Gallagher S. M. и Huo Y. [16,23,24] показано, что пациентам с консервативным лечением медицинскую помощь часто оказывают не кар диологи. Итогом этого является отсутствие инвазивного подхода к ведению пациентов высокого риска ишемиче ских событий и наоборот -проведение КАГ и ЧКВ паци ентам низкого риска.…”

Section: обзоры §unclassified

Management of patients with non-ST segment elevation acute coronary syndrome. Are all problems solved?

Барбараш¹,

Кашталап²

2016

RHJ

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Ключевые слова: ОКС, консервативное лечение, чрескожное коронарное вмешательство, сердечно-сосудистый риск Ссылка для цитирования: Барбараш О. Л., Кашталап В. В. Лечение пациентов с острым коронарным синдромом без подъема сегмента ST. Все ли проблемы решены? Сердце: журнал для практикующих врачей. 2016;15 (5):320-326 Резюме В обзорной статье, выполненной на основании данных актуальных клинических исследований, анализа современных рекомендаций по ведению больных и результатов регистровых протоколов, представлены различные аспекты проблемы ведения пациентов с ОКС без стойкого подъема сегмента ST по ЭКГ (ОКСбпST), обозначены нерешенные вопросы адекватной оценки и управления риском ишемических событий после ОКС, определены перспективные направления дальнейших исследований этой проблемы. Для написания обзорной статьи использованы доступные материалы из российских и зарубежных библиотечных баз данных (РИНЦ, Library's MEDLINE / PubMed database).Management of patients with non-ST segment elevation acute coronary syndrome. Are all problems solved?

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Long‐term antithrombotic management patterns in Asian patients with acute coronary syndrome: 2‐year observations from the EPICOR Asia study

Zheng

Huo

Lee

et al. 2020

Clinical Cardiology

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Background Despite guideline recommendations, dual antiplatelet therapy (DAPT) is frequently used for longer than 1 year after an acute coronary syndrome (ACS) event. In Asia, information on antithrombotic management patterns (AMPs), including DAPT post discharge, is sparse. This analysis evaluated real‐world AMPs up to 2 years post discharge for ACS. Hypothesis There is wide variability in AMP use for ACS management in Asia. Methods EPICOR Asia (NCT01361386) is a prospective observational study of patients discharged after hospitalization for an ACS in eight countries/regions in Asia, followed up for 2 years. Here, we describe AMPs used and present an exploratory analysis of characteristics and outcomes in patients who received DAPT for ≤12 months post discharge compared with >12 months. Results Data were available for 12 922 patients; of 11 639 patients discharged on DAPT, 2364 (20.3%) received DAPT for ≤12 months and 9275 (79.7%) for >12 months, with approximately 60% still on DAPT at 2 years. Patients who received DAPT for >12 months were more likely to be younger, obese, lower Killip class, resident in India (vs China), and to have received invasive reperfusion. Clinical event rates during year 2 of follow‐up were lower in patients with DAPT >12 vs ≤12 months, but no causal association can be implied in this non‐randomized study. Conclusions Most ACS patients remained on DAPT up to 1 year, in accordance with current guidelines, and over half remained on DAPT at 2 years post discharge. Patients not on DAPT at 12 months are a higher risk group requiring careful monitoring.

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Challenges and solutions in medically managed ACS in the Asia-Pacific region: Expert recommendations from the Asia-Pacific ACS Medical Management Working Group

Cited by 17 publications

References 102 publications

How do the cardiology services for patients presenting with acute coronary syndromes compare between developing and developed countries?

How do the cardiology services for patients presenting with acute coronary syndromes compare between developing and developed countries?

Management of patients with non-ST segment elevation acute coronary syndrome. Are all problems solved?

Long‐term antithrombotic management patterns in Asian patients with acute coronary syndrome: 2‐year observations from the EPICOR Asia study

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