Abstract
BackgroundThere are limited contemporary data on the presentation, management and outcomes of acute coronary syndromes (ACS) in Sri Lanka. We aimed to identify the critical issues that limit optimal management of ACS in Sri Lanka.MethodsWe performed a prospectively observational study of 256 consecutive patients who presented with ACS between November 2011 and May 2012 at a tertiary care general medical unit in Sri Lanka.ResultsWe evaluated data on presentation, management, in-hospital mortality, and major adverse cardiovascular events (MACE) of participants. Smoking, alcohol abuse, and obesity were more common in patients with ST elevation myocardial infarction (STEMI) (P < 0.05). Discharge diagnoses were STEMI in 32.8 % (84/256) and unstable angina (UA)/non-ST elevation myocardial infarction [NSTEMI] in 67.1 % (172/256) of participants. The median time (IQR) from onset of pain to presentation was 60 (319) minutes for STEMI and 120 (420) for UA/NSTEMI (P = 0.058). A median delay of 240 min was noted in patients who had presented initially to smaller hospitals. Cardiac markers were assessed in only 35 % of participants. In-hospital anti-platelet use was high (>92 %). Only 70.2 % of STEMI patients received fibrinolytic therapy. Fewer than 20 % of patients were received fibrinolytic therapy within 30 min of arrival. Major adverse cardiac events (MACE) were recorded in 11.9 % of subjects with STEMI and 11.6 % of those with UA/NSTEMI (P = 0.5). According to logistic regression analysis, body mass index (P = 0.045) and duration of diabetes (P = 0.03) were significant predictors of in-hospital MACE. On discharge, aspirin, thienopyridine, and statins were prescribed to more than 90 % of patients. Only one patient underwent coronary angiography during the index admission.ConclusionsDelays in presentation and in initiation of thrombolytic therapy and coronary interventions are key hurdles that need attention to optimize ACS care in Sri Lanka.
Highlights
There are limited contemporary data on the presentation, management and outcomes of acute coronary syndromes (ACS) in Sri Lanka
Data from 2004–2012 show a steady increase in mortality from Ischemic heart disease (IHD) in hospitals; in 2012 IHD accounted for 14.4 % of all deaths in hospitals in Sri Lanka [6]
The aim of the current study was to gain insights into the following aspects of ACS: epidemiology, presentation, in-ward management, and adherence to current management guidelines, for patients admitted to a tertiary care hospital in Sri Lanka
Summary
There are limited contemporary data on the presentation, management and outcomes of acute coronary syndromes (ACS) in Sri Lanka. Mortality from CVD in Sri Lanka is recognized to be one of the highest causes of death worldwide [5]. Ischemic heart disease (IHD) is the leading cause of death in Sri Lanka, accounting for 27.6 deaths per 100,000 people. Data from 2004–2012 show a steady increase in mortality from IHD in hospitals; in 2012 IHD accounted for 14.4 % of all deaths in hospitals in Sri Lanka [6]. This high mortality rate remains unexplained, Medagama et al BMC Cardiovascular Disorders (2015) 15:133 but may be attributable in part to a combination of modifiable and non-modifiable cardiovascular risk factors. Previous research has shown that management of CVD in Sri Lanka [7,8,9], regionally [10], and in developing countries is generally suboptimal compared to Western developed countries [11]
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