1
|
Dewi PEN, Sunantiwat M, Thavorncharoensap M, Youngkong S, Nathisuwan S, Rahajeng B. Treatment seeking experiences of ACS patients in Yogyakarta, Indonesia during COVID-19 pandemic: A qualitative study. PLoS One 2024; 19:e0302320. [PMID: 38687806 PMCID: PMC11060526 DOI: 10.1371/journal.pone.0302320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 04/02/2024] [Indexed: 05/02/2024] Open
Abstract
Delay in treatment seeking is recognized as a major contributor for Acute Coronary Syndrome (ACS) mortality in Indonesia. Despite the significance of timely treatment, decline in admission and delay in presentation of patients with ACS were consistently reported during the COVID-19 pandemic. These suggested that treatment seeking performance of patients during the pandemic might be different from the previous period. This qualitative study aimed to explore treatment seeking behaviour, barriers in seeking medical treatment, and experiences of patients with ACS in Yogyakarta, Indonesia during COVID-19 pandemic. In depth-interviews were carried out with 30 patients, who were hospitalized with ACS at one of the three selected hospitals in Yogyakarta during the pandemic period. Thematic analysis was performed to create vital explanations for treatment seeking practices of patients with ACS during pandemic. Three significant themes were identified: treatment seeking decisions, barriers in seeking medical treatment during COVID-19, and experiencing both good and bad impression from entering and staying in the hospital. The intensity of ACS symptoms and fear of COVID-19 infection dominated the delay in seeking medical treatment. Strict safety measures, religious belief, and fear of ACS helped patients overcome barriers and seek medical treatment during pandemic. ACS patients also had convenient medical care during the pandemic and believed medical staff would provide excellent care to them. However, visit restriction policy could cause psychological discomfort. Increase awareness of ACS symptoms and the risk of delays ACS treatment are essential to support patients' decisions to seek medical helps in a timely manner at any situations including pandemic. Interventions aim at alleviating psychological distress should also be designed and implemented to improve treatment experiences of ACS patients, who sought medical treatment during the pandemic crisis.
Collapse
Affiliation(s)
- Pramitha Esha Nirmala Dewi
- Doctor of Philosophy Program in Social, Economic, and Administrative Pharmacy, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
- Department of Pharmacy Profession, Faculty of Medicine and Health Sciences, Universitas Muhammadiyah Yogyakarta, Bantul, Indonesia
| | - Montaya Sunantiwat
- Social and Administrative Pharmacy Excellence Research (SAPER) Unit, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
| | - Montarat Thavorncharoensap
- Social and Administrative Pharmacy Excellence Research (SAPER) Unit, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
- Health Technology Assessment Graduate Program, Mahidol University, Bangkok, Thailand
| | - Sitaporn Youngkong
- Social and Administrative Pharmacy Excellence Research (SAPER) Unit, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
- Health Technology Assessment Graduate Program, Mahidol University, Bangkok, Thailand
| | - Surakit Nathisuwan
- Clinical Pharmacy Division, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
| | - Bangunawati Rahajeng
- Department of Pharmacy Profession, Faculty of Medicine and Health Sciences, Universitas Muhammadiyah Yogyakarta, Bantul, Indonesia
| |
Collapse
|
2
|
Alkatiri AH, Qalby N, Mappangara I, Zainal ATF, Cramer MJ, Doevendans PA, Qanitha A. Stress hyperglycemia and poor outcomes in patients with ST-elevation myocardial infarction: a systematic review and meta-analysis. Front Cardiovasc Med 2024; 11:1303685. [PMID: 38529334 PMCID: PMC10961461 DOI: 10.3389/fcvm.2024.1303685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 02/15/2024] [Indexed: 03/27/2024] Open
Abstract
Background Hyperglycemia, characterized by elevated blood glucose levels, is frequently observed in patients with acute coronary syndrome, including ST-elevation myocardial infarction (STEMI). There are conflicting sources regarding the relationship between hyperglycemia and outcomes in STEMI patients. We aimed to compile evidence to assess the association between hyperglycemia and adverse outcomes. Methods We conducted a comprehensive search for articles on PubMed and Embase using search strategies which yielded 4,061 articles. After full-text screening, 66 articles were included for systematic review, and 62 articles were further selected for meta-analysis. Results The 66 included articles spanned the years 2005-2023. Of these, 45 articles reported admission blood glucose, 13 articles used HbA1c, and 7 articles studied fasting blood glucose. Most studies defined STEMI with primary PCI as their inclusion criteria. Mortality was the most often outcome reported related to hyperglycemia. Overall, 55 (83.3%) studies were at low risk of bias. Both admission and fasting blood glucose were significantly related to short- and long-term mortality after STEMI, with a pooled risk ratio (RR) of 3.02 (95%CI: 2.65-3.45) and 4.47 (95% CI: 2.54-7.87), respectively. HbA1c showed substantial association with long-term mortality (HR 1.69, 95% CI: 1.31-2.18)) with a pooled RR of 1.58 (95% CI 1.26-1.97). In subsequent analyses, admission hyperglycemia was associated with an increased risk of reinfarction (pooled RR 1.69, 95% CI 1.31-2.17), heart failure (pooled RR 1.56, 95% CI: 1.37-1.77), cardiogenic shock (pooled RR 3.68, 95% CI 2.65-5.11), repeat PCI or stent thrombosis (pooled RR 1.99, 95% CI 1.21-3.28), and composite major adverse cardiac and cerebrovascular events (MACCE) (pooled RR 1.99, 95% CI: 1.54-2.58). Conclusions Our study demonstrated that hyperglycemia has a strong association with poor outcomes after STEMI. Admission and fasting blood glucose are predictors for short-term outcomes, while HbA1c is more appropriate for predicting longer-term outcomes in STEMI patients. Systematic Review Registration PROSPERO 2021 (CRD42021292985).
Collapse
Affiliation(s)
- Abdul Hakim Alkatiri
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
- Makassar Cardiac Center, Dr. Wahidin Sudirohusodo General Teaching Hospital, Makassar, Indonesia
| | - Nurul Qalby
- Department of Public Health and Community Medicine, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
- Heart and Lung Division, Department of Cardiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Idar Mappangara
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
- Makassar Cardiac Center, Dr. Wahidin Sudirohusodo General Teaching Hospital, Makassar, Indonesia
| | | | - Maarten J. Cramer
- Heart and Lung Division, Department of Cardiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Pieter A. Doevendans
- Heart and Lung Division, Department of Cardiology, University Medical Center Utrecht, Utrecht, Netherlands
- Netherlands Heart Institute, Utrecht, Netherlands
| | - Andriany Qanitha
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
- Department of Physiology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
- Doctoral Study Program, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| |
Collapse
|
3
|
Khan R, Kaul P, Islam S, Savu A, Bagai A, van Diepen S, Bainey KR, Welsh RC, Goodman SG. Drug Adherence and Long-Term Outcomes in Non-Revascularized Patients Following Acute Myocardial Infarction. Am J Cardiol 2021; 152:49-56. [PMID: 34120704 DOI: 10.1016/j.amjcard.2021.04.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 04/09/2021] [Accepted: 04/13/2021] [Indexed: 12/29/2022]
Abstract
This study examined long-term outcomes and adherence to guideline-based medications in non-revascularized acute myocardial infarction (MI) patients undergoing and not undergoing angiography. We analyzed non-revascularized MI patients hospitalized in Alberta, Canada between 2010-2016 and categorized them according to whether they had undergone coronary angiography. Adherence to guideline-based medications was determined by the proportion of days covered (PDC) and subdivided into categories based on PDC: 0% (none), 1-40% (low), 40-79% (intermediate) and ≥ 80% (high). Patients not undergoing angiography were older, less frequently male, and had more comorbidities. Those not receiving angiography had higher rates of 2-year myocardial infarction (9.9% vs 6.1%, p <0.001), heart failure (14.9% vs 6.1%, p <0.001), and mortality (29.4% vs 7.4%, p <0.001). Optimal medial therapy (OMT), defined by high PDC for the combination of lipid-modifying agents, β-blockers and angiotensin converting enzyme-inhibitors/receptor blockers (ACE-I/ARBs), was achieved in 32.9%. Patients not undergoing angiography had lower rates of OMT adherence (p <0.001). In patients not undergoing angiography, high-adherence to lipid-modifying agents (HR 0.70 [95% CI 0.57-0.87]), β-blockers (HR 0.78 [0.62-0.97]), ACE-I/ARBs (HR 0.64 [0.52-0.79]) and OMT (HR 0.56 [0.40-0.77]) was independently associated with lower 2-year mortality. In conclusion, MI patients not receiving angiography had low adherence rates to guideline-based pharmacotherapies and high rates of long-term outcomes, suggesting potential treatment targets to improve prognosis in non-invasively managed MI patients.
Collapse
|
4
|
Desta DM, Nedi T, Hailu A, Atey TM, Tsadik AG, Asgedom SW, Kasahun GG, Ayalew E. Treatment outcome of acute coronary syndrome patients admitted to Ayder Comprehensive Specialized Hospital, Mekelle, Ethiopia; A retrospective cross-sectional study. PLoS One 2020; 15:e0228953. [PMID: 32053702 PMCID: PMC7018065 DOI: 10.1371/journal.pone.0228953] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 01/26/2020] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Acute coronary syndrome (ACS) is increasingly becoming a common cause of cardiovascular mortality in developing countries. Even though, there is an introduction of limited percutaneous coronary intervention and thrombolytic therapies, in-hospital mortality due to ACS still remains high in sub-Saharan countries. OBJECTIVE The aim of the study was to assess treatment outcome of ACS patients admitted to Ayder Comprehensive Specialized Hospital, Mekelle, Ethiopia. METHODS A retrospective cross-sectional study was done by collecting data from patients' medical records using a data abstraction tool. Data were analyzed using logistic regression to determine crude and adjusted odds ratio. At 95% confidence interval, p-value<0.05 was considered as statistically significant. RESULTS Of the total 151 patients, in-hospital mortality was found to be 24.5%, and hypertension was the most frequent (46.4%) risk factor of ACS. Concerning the management practice, catheterization and primary percutaneous coronary intervention were done in 27.1%, and 3.9% respectively. Additionally, in emergency setting loading dose of aspirin and clopidogrel were used in about 63.8% and 62.8%, respectively. The other frequently used medications were beta-blockers (86.9%), angiotensin converting enzymes/angiotensin receptor blockers (84.1%) and statins (84.1%). Streptokinase was administered in 6.3% of patients with ST-elevated myocardial infarction and heparins in 78.1% of them. The commonly prescribed discharge medications were aspirin (98.2%), statins (94.7%) and clopidogrel (92%). Non-use of beta-blockers (p = 0.014), in-hospital complication of cardiogenic shock (p = 0.001) and left ventricular ejection fraction of ≤ 30% (p = 0.032) were independent predictors of in-hospital mortality. CONCLUSION The proportion of in-hospital mortality due to ACS was found to be high. Therefore, timely evidence based therapy should be implemented in the setup.
Collapse
Affiliation(s)
- Desilu Mahari Desta
- Clinical Pharmacy Unit, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Teshome Nedi
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abraha Hailu
- Department of Internal Medicine, School of Medicine, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Tesfay Mehari Atey
- Clinical Pharmacy Unit, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Afewerki Gebremeskel Tsadik
- Clinical Pharmacy Unit, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Solomon Weldegebriel Asgedom
- Clinical Pharmacy Unit, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | | | - Eskinder Ayalew
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| |
Collapse
|
5
|
Qanitha A, Uiterwaal CSPM, Henriques JPS, Mappangara I, Amir M, Saing SG, de Mol BAJM. Adherence to guideline recommendations for coronary angiography in a poor South-East Asian setting: Impact on short- and medium-term clinical outcomes. Sci Rep 2019; 9:19163. [PMID: 31844078 PMCID: PMC6915772 DOI: 10.1038/s41598-019-55299-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 11/25/2019] [Indexed: 11/09/2022] Open
Abstract
In South-East Asian populations and particularly in Indonesia, access to coronary angiography (CAG) is limited. We aimed to assess the adherence for undergoing CAG for indicated patients, according to the guideline recommendations. We then examined whether this adherence would have an impact on patients' short- and medium-term mortality and morbidity. We consecutively enrolled 474 patients with acute and stable coronary artery disease who had indication for CAG at Makassar Cardiac Center, Indonesia from February 2013 to December 2014. We found that adherence to CAG recommendation in poor South-East Asian setting is low. Of 474 recommended patients, only 273 (57.6%) underwent the procedure. Factors for not undergoing CAG were: older age, female gender, low educational and socio-economic status, and insurance type. While reasons for patients refusing CAG and subsequent intervention included fear, symptoms reduction, and lack of trust concerning the procedure benefit. During follow-up (median 19 (IQR 6-39.3) months), 155 (32.7%) patients died, and 259 (54.6%) experienced at least one adverse event. Adherence to CAG recommendation was associated with a significantly lower short- and medium-term mortality, independent of revascularization and other potential confounders. In sub-group analysis, adhered patients "with revascularization" had significantly better outcomes compared to the "non-revascularization" and "not adhere" groups.
Collapse
Affiliation(s)
- Andriany Qanitha
- Department of Cardio-thoracic Surgery, AMC Heart Center, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands. .,Department of Physiology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia.
| | - Cuno S P M Uiterwaal
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jose P S Henriques
- Department of Cardiology, AMC Heart Center, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Idar Mappangara
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Muzakkir Amir
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Sumarsono G Saing
- Makassar Cardiac Center, Catheterization Laboratory Unit, DR. Wahidin Sudirohusodo Hospital, Makassar, Indonesia
| | - Bastianus A J M de Mol
- Department of Cardio-thoracic Surgery, AMC Heart Center, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
6
|
Nascimento BR, Brant LCC, Marino BCA, Passaglia LG, Ribeiro ALP. Implementing myocardial infarction systems of care in low/middle-income countries. Heart 2018; 105:20-26. [DOI: 10.1136/heartjnl-2018-313398] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 09/01/2018] [Accepted: 09/05/2018] [Indexed: 01/09/2023] Open
Abstract
Ischaemic heart disease is the leading cause of death worldwide, with an increasing trend from 6.1 million deaths in 1990 to 9.5 million in 2016, markedly driven by rates observed in low/middle-income countries (LMIC). Improvements in myocardial infarction (MI) care are crucial for reducing premature mortality. We aimed to evaluate the main challenges for adequate MI care in LMIC, and possible strategies to overcome these existing barriers.Reperfusion is the cornerstone of MI treatment, but worldwide around 30% of patients are not reperfused, with even lower rates in LMIC. The main challenges are related to delays associated with patient education, late diagnosis and inadequate referral strategies, health infrastructure and insufficient funding. The implementation of regional MI systems of care in LMIC, systematising timely reperfusion strategies, access to intensive care, risk stratification and use of adjunctive medications have shown some successful strategies. Telemedicine support for remote ECG, diagnosis and organisation of referrals has proven to be useful, improving access to reperfusion even in prehospital settings. Organisation of transport and referral hubs based on anticipated delays and development of MI excellence centres have also resulted in better equality of care. Also, education of healthcare staff and task shifting may potentially widen access to optimal therapy.In conclusion, efforts have been made for the implementation of MI systems of care in LMIC, aiming to address particularities of the health systems. However, the increasing impact of MI in these countries urges the development of further strategies to improve reperfusion and reduce system delays.
Collapse
|