Presentation, management, and outcomes of 25 748 acute coronary syndrome admissions in Kerala, India: results from the Kerala ACS Registry

Mohanan, P.P.; Mathew, Rony; Harikrishnan, S; Krishnan, M.N.; Zachariah, George; Joseph, Jhony; Eapen, K. J.; Abraham, Mathew; Menon, Jaideep; Thomas, Manoj; Jacob, Sonny; Huffman, Mark D.; Prabhakaran, Dorairaj

doi:10.1093/eurheartj/ehs219

Cited by 216 publications

(293 citation statements)

References 14 publications

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“…They had fewer risk factors, and a less frequent history of prior cardiac disease or intervention; they were, however, more often smokers, and significantly higher inhospital mortality rate, compared to NSTEMI. These findings reflect those observed in regional registries such as CREATE, Kerala ACS and ACCESS 7,8,21 , as well as those from high income countries (AR-G registries-ACS II registries) [22][23][24] , reflecting a pattern of a generally greater co-morbidities and higher number of risk factors among NSTE-ACS patients.…”

Section: Discussionsupporting

confidence: 77%

“…The mean age of our subjects was a relatively young age of 57.8 ± 12.1 years, which is comparable with those of the CREATEand middle eastern registries (GulfRACE and SPACE) 7,16,17 ,marginally lower than the Kerala ACS registry 8 and ACCESS registry 21 , but significantly younger than those of Thai ACSRegistry, GRACE, ACTION AR-G and other European registries 13,18,[22][23][24] , reflecting the younger presentation of ACS among Bangladeshis.…”

Section: Discussionsupporting

confidence: 65%

“…Hypertension,diabetes and dyslipidaemia showed much greater incidence in our population in comparison to other Asian and Western registries. In fact, the incidence of diabetes we report may be one of the highest rates of diabetes in an ACS population, which is triple the rates reported in the multinational GRACE registry 18,19 , and almost double the rates reported in Indian studies 7,8 . The presence of CKD, an additional risk factor contributing to poor outcome, was as high as 20.7% in this ACS population, possibly linked to the high prevalence of concomitant diabetes and hypertension.…”

Section: Discussionsupporting

confidence: 40%

“…This is in contrast to most Asian registries and the GRACE registry, where STEMI was the most common presentation of ACS 7,8,11,13,16 . In both the Euro Heart Surveys, SPACE registry and a more contemporary Indian study, NSTEMI was the more common diagnosis 9,16,22,23 .53.4% of all ACS patients in our registry underwent coronary angiography.…”

Section: Discussionmentioning

confidence: 68%

“…These data have shown regional variation in the clinical presentations, use of invasive procedures and outcomes across the spectrum of ACS, across different regions of the world.In the South Asian region, two large registries in India [7][8] have documented the demographic characteristics, treatment practices and outcomes of ACS patients.…”

Section: Introductionmentioning

confidence: 99%

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Presentation, Management Practices and In-hospital Outcomes of Patients with Acute Coronary Syndrome in a Tertiary Cardiac Centre in Bangladesh

et al. 2018

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Section: Discussionsupporting

confidence: 77%

Section: Discussionsupporting

confidence: 65%

Section: Discussionsupporting

confidence: 40%

Section: Discussionmentioning

confidence: 68%

Section: Introductionmentioning

confidence: 99%

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Presentation, Management Practices and In-hospital Outcomes of Patients with Acute Coronary Syndrome in a Tertiary Cardiac Centre in Bangladesh

et al. 2018

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Improving Evidence for Implementation of Guideline-Based Care in Low- and Middle-Income Countries

Granger

Xavier

2018

JAMA

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Coronary heart disease is the number one cause of death and disability in India and around the world. 1 Evidence-based approaches for prevention and treatment of coronary heart disease are widely available but are not used optimally, particularly in low-and middleincome countries. 2,3 In India, like in many countries, there are major gaps between actual and ideal care, and quality of care is substantially worse for patients with low socioeconomic status. 4 Studies of quality improvement in Brazil, 5 China, 6 and India 7 have been associated with improvements in acute coronary syndrome care [5][6][7] and in clinical outcomes. 7 However, there is an important need to further develop approaches to improve implementation of evidence-based care in these countries.Certain principles apply to implementing guidelines in any health care setting, as summarized by reviews of the evidence of what has been shown to be effective. 8 Effective strategies have been multifaceted, as there are numerous aspects to implementation such that any one element, such as physician reminders or a care pathway, is unlikely to make a large difference. Audit and feedback are important, and data collection is essential: if implementation strategies and outcomes are not measured, they cannot be improved. Targeted interactive education such as with outreach visits by experts from outside the practice setting is important.The interventions must also be customized to account for the barriers of the local health care setting. Understanding the gaps and barriers is a requirement for developing effective interventions in any health care system. In India, barriers to optimal care of acute coronary syndromes vary by region. These include financial barriers for patients and their families, transportation limitations in both rural (lack of transportation modes) and urban (heavy traffic) settings, lack of sophisticated emergency medical services, and inadequate integrated information systems to track patients through systems of care. Solutions have included use of cell phones for efficient transfer of information, including to patients and their families, and use of nonphysician health care workers to educate patients and their families, especially after discharge from the hospital, when use of effective treatments begins to wane. 9 Progressively more rigorous approaches have been developed for generation of evidence regarding what works for implementing guidelines. Most quality improvement programs have used a pre/post design, in which performance and outcomes are measured over time as an intervention to improve care is implemented. Although this use of a "historical control" group can be compelling, secular trends in both

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Effect of a Quality Improvement Intervention on Clinical Outcomes in Patients in India With Acute Myocardial Infarction

Huffman

Mohanan²,

Devarajan

et al. 2018

JAMA

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Presentation, management, and outcomes of 25 748 acute coronary syndrome admissions in Kerala, India: results from the Kerala ACS Registry

Cited by 216 publications

References 14 publications

Presentation, Management Practices and In-hospital Outcomes of Patients with Acute Coronary Syndrome in a Tertiary Cardiac Centre in Bangladesh

Presentation, Management Practices and In-hospital Outcomes of Patients with Acute Coronary Syndrome in a Tertiary Cardiac Centre in Bangladesh

Improving Evidence for Implementation of Guideline-Based Care in Low- and Middle-Income Countries

Effect of a Quality Improvement Intervention on Clinical Outcomes in Patients in India With Acute Myocardial Infarction

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