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

Lodi-Junqueira, Lucas; Ribeiro, Antônio Luiz Pinho

doi:10.1136/heartjnl-2018-313013

Cited by 7 publications

(9 citation statements)

References 8 publications

(4 reference statements)

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“…Over the past decades, acute coronary syndrome (ACS) management has improved significantly following technological and pharmaceutical innovations that have led to improved pre-hospital diagnosis and treatments, more rapid admission to hospital, greater use of proven therapies delivered in coronary care units, increased use of defibrillators, pace-makers and acute percutaneous coronary interventions, drugs (anti-platelets, heparin, thrombolytics, beta-blockers, angiotensin-converting enzyme inhibitors and statins), and appropriate cardiac rehabilitation [13]. Many of these therapies are underused in most LLMICs [13–15], especially among those of low SES [7, 14]. The factors of importance leading to greater mortality in individuals of low SES in LLMICs include the poor access and availability of lifesaving therapies as well as a low quality of care [7, 14–16].…”

Section: Acute Coronary Syndrome Managementmentioning

confidence: 99%

“…Many of these therapies are underused in most LLMICs [13–15], especially among those of low SES [7, 14]. The factors of importance leading to greater mortality in individuals of low SES in LLMICs include the poor access and availability of lifesaving therapies as well as a low quality of care [7, 14–16]. The implementation of guideline-based management of ACS using validated protocols could facilitate better management.…”

Section: Acute Coronary Syndrome Managementmentioning

confidence: 99%

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Challenges in management and prevention of ischemic heart disease in low socioeconomic status people in LLMICs

Gupta

Yusuf

2019

BMC Med

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BackgroundCardiovascular diseases, principally ischemic heart disease (IHD), are the most important cause of death and disability in the majority of low- and lower-middle-income countries (LLMICs). In these countries, IHD mortality rates are significantly greater in individuals of a low socioeconomic status (SES).Main textThree important focus areas for decreasing IHD mortality among those of low SES in LLMICs are (1) acute coronary care; (2) cardiac rehabilitation and secondary prevention; and (3) primary prevention. Greater mortality in low SES patients with acute coronary syndrome is due to lack of awareness of symptoms in patients and primary care physicians, delay in reaching healthcare facilities, non-availability of thrombolysis and coronary revascularization, and the non-affordability of expensive medicines (statins, dual anti-platelets, renin-angiotensin system blockers). Facilities for rapid diagnosis and accessible and affordable long-term care at secondary and tertiary care hospitals for IHD care are needed. A strong focus on the social determinants of health (low education, poverty, working and living conditions), greater healthcare financing, and efficient primary care is required. The quality of primary prevention needs to be improved with initiatives to eliminate tobacco and trans-fats and to reduce the consumption of alcohol, refined carbohydrates, and salt along with the promotion of healthy foods and physical activity. Efficient primary care with a focus on management of blood pressure, lipids and diabetes is needed. Task sharing with community health workers, electronic decision support systems, and use of fixed-dose combinations of blood pressure-lowering drugs and statins can substantially reduce risk factors and potentially lead to large reductions in IHD. Finally, training of physicians, nurses, and health workers in IHD prevention should be strengthened.ConclusionThe management and prevention of IHD in individuals with a low SES in LLMICs are poor. Greater availability, access, and affordability for acute coronary syndrome management and secondary prevention are important. Primary prevention should focus on tackling the social determinants of health as well as policy and individual interventions for risk factor control, supported by task sharing and use of technology.

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Section: Acute Coronary Syndrome Managementmentioning

confidence: 99%

Section: Acute Coronary Syndrome Managementmentioning

confidence: 99%

Challenges in management and prevention of ischemic heart disease in low socioeconomic status people in LLMICs

Gupta

Yusuf

2019

BMC Med

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“…Loss to follow up of patient outcomes in this study was 20.1% at one year for mortality (47.2% for quality of recovery) and may be masking signi cantly higher mortality. In this study, expired mobile phone numbers provided by patients for follow up was the main reason for failure to contact patients after discharge and may point to survival bias [24]. This hypothesis is supported by the minimal loss to follow up once initial telephone contact was made.…”

Section: Discussionmentioning

confidence: 62%

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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“…Cardiovascular disease is a major cause of death globally, and has overtaken infectious diseases as the primary cause of death in South Asia. Delivery of high-quality cardiovascular disease care, as with other non-communicable diseases, places a significant burden on primary, secondary, tertiary and supportive health services 1–3. Addressing quality of care in patients with acute myocardial infarction (AMI) in LMICs could thus have major impact on patient outcomes.…”

Section: Introductionmentioning

confidence: 99%

Quality evaluation and future priorities for delivering acute myocardial infarction care in Sri Lanka

Beane

Ranasinghe

Vithanage

et al. 2019

Heart

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AimThis study evaluates the quality of care for patients admitted with acute myocardial infarction (AMI) in a tertiary hospital in Colombo using the European Society of Cardiology Quality of Care Working Group’s guidelines (2017).MethodsA recently implemented electronic AMI registry m-Health tool was used for prospective data collection. Each patient was assessed for eligibility for each of the six domains of quality. Global Registry of Acute Coronary Events Risk Model for predicted probability of mortality, and scores for risk of bleeding complications (CRUSADE) and severity of heart failure (Killip classification) were calculated as per published guidelines. A composite measure of quality was derived from compliance with the six domains. Patients were followed up via telephone at 30 days following discharge to evaluate outcome and satisfaction. Organisational information was assessed by administrative review and interview.ResultsBetween March 2017 and April 2018, 934 patients with AMI presented to the cardiology department. The majority of patients (90.4%) presented with features of ST-elevation myocardial infarction (STEMI). Mean (SD) overall compliance with the composite quality indicator (CQI) was 44% (0.07). Compliance of ≥50% to the CQI was achieved in 9.8% of STEMI patients. The highest compliance was observed for antithrombotics during hospitalisation (79.1%) and continuous measure of patient satisfaction (76.1%). The lowest compliance was for organisational structure and care processes (22.4%).ConclusionThis study reports a registry-based continuous evaluation of the quality of AMI care from a low and middle-income country. Priorities for improvement include improved referral, and networking of primary and secondary health facilities with the percutaneous coronary intervention centre.

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

Cited by 7 publications

References 8 publications

Challenges in management and prevention of ischemic heart disease in low socioeconomic status people in LLMICs

Challenges in management and prevention of ischemic heart disease in low socioeconomic status people in LLMICs

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

Quality evaluation and future priorities for delivering acute myocardial infarction care in Sri Lanka

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