Quality of Acute Coronary Syndrome Care and in-hospital Outcome in a Resource-poor Setting in Northern Ghana

Abstract

Background African countries are facing an epidemic of cardiovascular diseases for which they lack the resources to diagnose and manage adequately. Information on the quality of acute coronary syndrome care offered in underserved communities in low to middle-income countries like Ghana is limited. We examined the quality of acute coronary syndrome care offered to patients presenting to the Tamale Teaching Hospital in Northern Ghana. Methods We conducted a retrospective review of the medical records of patients ≥ 18 years with acute coronary syndrome managed in the Tamale Teaching Hospital of Northern Ghana from January 2021 to December 2022. We characterised the clinical profile of these patients and assessed in-hospital outcomes and the extent of compliance to key performance and quality indicators as contained in the 2017 American Heart Association /American College of Cardiology guideline for adults with myocardial infarction. Results Between January 2021 and December 2022, 62 patients with a mean age of 56.0 ± 16.1 years were admitted with acute coronary syndrome. Median time to hospital presentation after symptom onset was 24 hours (IQR 15–96 hours). 33.9% had ST-elevation myocardial infarction, of which only 14.3% received reperfusion therapy. About three-quarters of patients received dual antiplatelet therapy at discharge (78.2%), with fewer patients receiving recommended high-intensity statin therapy (65.5%) or beta-blockers (69.1%). Only 38.2% of patients had their left ventricular ejection fraction documented. Among those with documented left ventricular systolic dysfunction, 75% were prescribed an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker at discharge. No cardiac rehabilitation program existed. Risk stratification of patients with non-ST-elevation myocardial infarction or stress tests for conservatively managed patients was not part of routine practice. Conclusion Acute coronary syndrome management remains a challenging issue in Northern Ghana. Several gaps exist in the care quality, timeliness of interventions and rehabilitation of affected patients. There is an urgent need for measures to improve the delivery of acute coronary syndrome care alongside primary prevention strategies.