Management of acute coronary syndrome in a tertiary care general medical unit in Sri Lanka: how closely do we follow the guidelines?

Abstract

Acute coronary syndrome (ACS) is a leading cause of death. Correct implementation of evidence-based guidelines should improve outcome. We conducted this study to determine to what extent management of ACS in a tertiary care medical ward in Sri Lanka adhered to current guidelines. This prospective observational study was carried out in the University Medical Unit of the National Hospital, Colombo, Sri Lanka, for a 5-month period commencing April 2008. All patients presenting with ACS to the unit were included. During the period of study, there were 101 admissions of confirmed ACS. Thirty-one (30.6%) and 40 (39.6%) patients had not received the required correct loading dose of aspirin and clopidogrel, respectively. There were 34 cases of ST-elevation myocardial infarction (STEMI); 26 patients were eligible for thrombolysis and streptokinase was given to 22 (84.6%). The rest were treated with low-molecular-weight heparin (LMWH). Of the 67 patients who did not have STEMI, 66 received the correct dose of LMWH. Fifty-two patients (51.4%) were started on a b-blocker at presentation. None of the patients received intravenous b-blockers. Seventy-four patients (73.2%) were started on either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker on presentation. None of the patients underwent primary percutaneous intervention. Adherence to guidelines is limited by lack of funds and resources in our setting; however, attention must be paid to non-costly easily correctable deficits.