Management, characteristics and outcomes of patients with acute coronary syndrome in Sri Lanka

Galappatthy, Priyadarshani; Bataduwaarachchi, Vipula R; Ranasinghe, Priyanga; Galappatthy, Gamini; Wijayabandara, Maheshi; Warapitiya, Dinuka S.; Sivapathasundaram, Mythily; Wickramarathna, Thilini N.; Senarath, Upul; Sridharan, Srinivasan; Wijeyaratne, Chandrika; Ekanayaka, Ruvan

doi:10.1136/heartjnl-2017-312404

Cited by 17 publications

(23 citation statements)

References 22 publications

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“…While data from tertiary hospitals located in urban areas in Brazil19 28 29 and in Sri Lanka30 showed prescription of over 80% of the drugs recommended by guidelines, utilisation rates were much lower in other studies performed in rural Brazil10 India16 and Chile 31. There are multiple causes for the low use of essential drugs, including irregular availability, absence of or non-adherence to clinical protocols and lack of training or feedback by quality assurance programmes.…”

Section: Barriers For MI Systems Of Care Implementation In Lmicsmentioning

confidence: 82%

Implementing myocardial infarction systems of care in low/middle-income countries

Nascimento

Brant

Marino

et al. 2018

Heart

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Ischaemic heart disease is the leading cause of death worldwide, with an increasing trend from 6.1 million deaths in 1990 to 9.5 million in 2016, markedly driven by rates observed in low/middle-income countries (LMIC). Improvements in myocardial infarction (MI) care are crucial for reducing premature mortality. We aimed to evaluate the main challenges for adequate MI care in LMIC, and possible strategies to overcome these existing barriers.Reperfusion is the cornerstone of MI treatment, but worldwide around 30% of patients are not reperfused, with even lower rates in LMIC. The main challenges are related to delays associated with patient education, late diagnosis and inadequate referral strategies, health infrastructure and insufficient funding. The implementation of regional MI systems of care in LMIC, systematising timely reperfusion strategies, access to intensive care, risk stratification and use of adjunctive medications have shown some successful strategies. Telemedicine support for remote ECG, diagnosis and organisation of referrals has proven to be useful, improving access to reperfusion even in prehospital settings. Organisation of transport and referral hubs based on anticipated delays and development of MI excellence centres have also resulted in better equality of care. Also, education of healthcare staff and task shifting may potentially widen access to optimal therapy.In conclusion, efforts have been made for the implementation of MI systems of care in LMIC, aiming to address particularities of the health systems. However, the increasing impact of MI in these countries urges the development of further strategies to improve reperfusion and reduce system delays.

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Section: Barriers For MI Systems Of Care Implementation In Lmicsmentioning

confidence: 82%

Implementing myocardial infarction systems of care in low/middle-income countries

Nascimento

Brant

Marino

et al. 2018

Heart

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“…It is, however, not uncommon for follow up studies of AMI patients in high income healthcare settings to describe loss to follow up as high as 50% [22]. In LMIC settings the challenges are often greater; absence of a unique patient identi ers in health systems, no national registry of patients' admission to healthcare facilities, low penetrance of landline telephones and relatively mobile urban populations, all of which hampers efforts to follow patients [1,13,22].…”

Section: Discussionmentioning

confidence: 99%

“…Recent studies evaluating the quality of these services have highlighted that whilst this investment has resulted in greater access to lifesaving reperfusion intervention, gaps in the quality of care across the continuum may be resulting in higher than predicted mortality at hospital discharge. Identi ed priorities for improving hospital outcomes include reducing delays in access to de nitive treatment and improved prescription of secondary preventative therapies at discharge [1][2][3].…”

Section: Introductionmentioning

confidence: 99%

Outcomes and Quality of Recovery at One Year Following Percutaneous Coronary Intervention for ST Elevation Myocardial Infarction in Sri Lanka

Ranasinghe

Beane

Priyadarshani³

et al. 2020

Preprint

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Background . Long term quality of recovery following percutaneous coronary intervention in Sri Lanka are unknown. We evaluated quality of recovery at one year, compliance with secondary prevention medications and access to and uptake of cardiac rehabilitation services. Methods . The GRACE Risk Model was used to compare predicted and actual mortality at hospital discharge and at one-year. Quality of recovery was assessed by the Seattle Angina Questionnaire. Compliance with secondary prevention therapy was assessed using international guidelines. Access to cardiac rehabilitation was assessed via telephone- administered interview. Results . Between April 2017 and March 2018, 699 consecutive patients underwent percutaneous coronary intervention. Mortality at one year was 13.6% (93); predicted mortality was (4.5–11%). Functional activity was significantly worse at one year 64.4 (75.6–55.6) compared to pre-admission (100, 100 − 84.4) (P-value < 0.01). Frequency of angina was greater at one year (80, IQR = 100 − 60), compared with 1-month post-discharge (100[IQR = 100 − 80], P-value < 0.01). Stability of angina remained unchanged (median[IQR] = 72[100 − 50]). Patients’ perceptions of treatment satisfaction were high (P-value < 0.01), disease perceptions worsened (P-value < 0.01). Self-perceived compliance with secondary prevention therapy ranged from 75%-82%. Of the 362 patients followed up 146 (44.5%) reported being offered the opportunity to attend cardiac rehabilitation; 128 (87.7%) attended. Conclusions . Outcomes at one year were poorer than expected. Patient-reported levels of satisfaction were high, despite worsening burden of symptoms. Research is needed to better understand patients' expectations of quality of acute myocardial infarction care.

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“…In their Heart manuscript, Galappatthy and colleagues4 presented the results of The ACS Sri Lanka Audit Project (ACSSLAP), a prospective cohort of patients with ACS treated in the public healthcare system in Sri Lanka. It was the first nationwide study in a LMIC to assess management, clinical outcomes, prevalence of risk factors and discharge care plans in ACS.…”

mentioning

confidence: 99%

Tackling acute coronary syndrome in low-income and middle-income countries

Lodi-Junqueira

Ribeiro

2018

Heart

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Management, characteristics and outcomes of patients with acute coronary syndrome in Sri Lanka

Cited by 17 publications

References 22 publications

Implementing myocardial infarction systems of care in low/middle-income countries

Implementing myocardial infarction systems of care in low/middle-income countries

Outcomes and Quality of Recovery at One Year Following Percutaneous Coronary Intervention for ST Elevation Myocardial Infarction in Sri Lanka

Tackling acute coronary syndrome in low-income and middle-income countries

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