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Ilic I, Radunovic A, Matic M, Zugic V, Ostojic M, Stanojlovic M, Kojic D, Boskovic S, Borzanovic D, Timcic S, Radoicic D, Dobric M, Tomovic M. Acute Coronary Syndrome Presenting during On- and Off-Hours: Is There a Difference in a Tertiary Cardiovascular Center? MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1420. [PMID: 37629710 PMCID: PMC10456505 DOI: 10.3390/medicina59081420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 07/11/2023] [Accepted: 07/14/2023] [Indexed: 08/27/2023]
Abstract
Background and Objectives: ACS presents an acute manifestation of coronary artery disease and its treatment is based on timely interventional diagnostics and PCI. It has been known that the treatment and the outcomes are not the same for all the patients with ACS during the working day, depending on the availability of the procedures and staff. The aim of the study was to explore the differences in clinical characteristics and outcomes in patients admitted for ACS during on- and off-hours. Materials and Methods: The retrospective study included 1873 consecutive ACS patients admitted to a tertiary, university hospital that underwent coronary angiography and intervention. On-hours were defined from Monday to Friday from 07:30 h to 14:30 h, while the rest was considered off-hours. Results: There were more males in the off-hours group (on-hours 475 (56%) vs. off-hours 635 (62%); p = 0.011), while previous MI was more frequent in the on-hours group (on 250 (30%) vs. off 148 (14%); p < 0.001). NSTEMI was more frequent during on-hours (on 164 (19%) vs. off 55 (5%); p < 0.001), while STEMI was more frequent during off-hours (on 585 (69%) vs. off 952 (93%); p < 0.001). Patients admitted during on-hours had more multivessel disease (MVD) (on 485 (57%) vs. off 489 (48%); p = 0.006), as well as multivessel PCI (on 187 (22%) vs. off 171 (16%); p = 0.002), while radial access was preferred in off-hours patients (on 692 (82%) vs. off 883 (86%); p = 0.004). Left main PCI was performed with similar frequency in both groups (on 37 (4%) vs. off 35 (3%); p = 0.203). Death occurred with similar frequency in both groups (on 17 (2.0%) vs. off 26 (2.54%); p = 0.404), while major adverse cardio-cerebral events (MACCEs) were more frequent in the on-hours group (on 105 (12.4%) vs. off 70 (6.8%); p = 0.039) probably due to the more frequent repeated PCI (on 49 (5.8%) vs. off 27 (2.6%); p = 0.035). Conclusions: Patients admitted for ACS during working hours in a tertiary hospital present with more complex CAD, have more demanding interventions, and experience more MACCEs during follow-up mostly due to myocardial infarctions and repeated procedures.
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Affiliation(s)
- Ivan Ilic
- Institute for Cardiovascular Diseases Dedinje, Heroja Milana Tepića 1, 11000 Belgrade, Serbia; (I.I.); (M.M.); (V.Z.); (D.K.); (S.B.); (D.B.); (S.T.); (D.R.); (M.D.); (M.T.)
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (M.O.); (M.S.)
| | - Anja Radunovic
- Institute for Cardiovascular Diseases Dedinje, Heroja Milana Tepića 1, 11000 Belgrade, Serbia; (I.I.); (M.M.); (V.Z.); (D.K.); (S.B.); (D.B.); (S.T.); (D.R.); (M.D.); (M.T.)
| | - Milica Matic
- Institute for Cardiovascular Diseases Dedinje, Heroja Milana Tepića 1, 11000 Belgrade, Serbia; (I.I.); (M.M.); (V.Z.); (D.K.); (S.B.); (D.B.); (S.T.); (D.R.); (M.D.); (M.T.)
| | - Vasko Zugic
- Institute for Cardiovascular Diseases Dedinje, Heroja Milana Tepića 1, 11000 Belgrade, Serbia; (I.I.); (M.M.); (V.Z.); (D.K.); (S.B.); (D.B.); (S.T.); (D.R.); (M.D.); (M.T.)
| | - Miljana Ostojic
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (M.O.); (M.S.)
| | - Milica Stanojlovic
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (M.O.); (M.S.)
| | - Dejan Kojic
- Institute for Cardiovascular Diseases Dedinje, Heroja Milana Tepića 1, 11000 Belgrade, Serbia; (I.I.); (M.M.); (V.Z.); (D.K.); (S.B.); (D.B.); (S.T.); (D.R.); (M.D.); (M.T.)
| | - Srdjan Boskovic
- Institute for Cardiovascular Diseases Dedinje, Heroja Milana Tepića 1, 11000 Belgrade, Serbia; (I.I.); (M.M.); (V.Z.); (D.K.); (S.B.); (D.B.); (S.T.); (D.R.); (M.D.); (M.T.)
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (M.O.); (M.S.)
| | - Dusan Borzanovic
- Institute for Cardiovascular Diseases Dedinje, Heroja Milana Tepića 1, 11000 Belgrade, Serbia; (I.I.); (M.M.); (V.Z.); (D.K.); (S.B.); (D.B.); (S.T.); (D.R.); (M.D.); (M.T.)
| | - Stefan Timcic
- Institute for Cardiovascular Diseases Dedinje, Heroja Milana Tepića 1, 11000 Belgrade, Serbia; (I.I.); (M.M.); (V.Z.); (D.K.); (S.B.); (D.B.); (S.T.); (D.R.); (M.D.); (M.T.)
| | - Dragana Radoicic
- Institute for Cardiovascular Diseases Dedinje, Heroja Milana Tepića 1, 11000 Belgrade, Serbia; (I.I.); (M.M.); (V.Z.); (D.K.); (S.B.); (D.B.); (S.T.); (D.R.); (M.D.); (M.T.)
| | - Milan Dobric
- Institute for Cardiovascular Diseases Dedinje, Heroja Milana Tepića 1, 11000 Belgrade, Serbia; (I.I.); (M.M.); (V.Z.); (D.K.); (S.B.); (D.B.); (S.T.); (D.R.); (M.D.); (M.T.)
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (M.O.); (M.S.)
| | - Milosav Tomovic
- Institute for Cardiovascular Diseases Dedinje, Heroja Milana Tepića 1, 11000 Belgrade, Serbia; (I.I.); (M.M.); (V.Z.); (D.K.); (S.B.); (D.B.); (S.T.); (D.R.); (M.D.); (M.T.)
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Qamar A, Bhatia K, Arora S, Hendrickson M, Gupta P, Fatima A, MP G, Bansal A, Batra V, Ricciardi MJ, Grines CL, Yusuf J, Mukhopadhyay S, Smith SC, Tyagi S, Bhatt DL, Gulati M, Gupta MD. Clinical Profiles, Outcomes, and Sex Differences of Patients With STEMI: Findings From the NORIN-STEMI Registry. JACC. ASIA 2023; 3:431-442. [PMID: 37396424 PMCID: PMC10308105 DOI: 10.1016/j.jacasi.2022.12.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 12/13/2022] [Accepted: 12/24/2022] [Indexed: 07/04/2023]
Abstract
Background Low- and middle-income countries account for most of the global burden of coronary artery disease. There is a paucity of data regarding epidemiology and outcomes for ST-segment elevation myocardial infarction (STEMI) patients in these regions. Objectives The authors studied the contemporary characteristics, practice patterns, outcomes, and sex differences in patients with STEMI in India. Methods NORIN-STEMI (North India ST-Segment Elevation Myocardial Infarction Registry) is an investigator-initiated prospective cohort study of patients presenting with STEMI at tertiary medical centers in North India. Results Of 3,635 participants, 16% were female patients, one-third were <50 years of age, 53% had a history of smoking, 29% hypertension, and 24% diabetes. The median time from symptom onset to coronary angiography was 71 hours; the majority (93%) presented first to a non-percutaneous coronary intervention (PCI)-capable facility. Almost all received aspirin, statin, P2Y12 inhibitors, and heparin on presentation; 66% were treated with PCI (98% femoral access) and 13% received fibrinolytics. The left ventricular ejection fraction was <40% in 46% of patients. The 30-day and 1-year mortality rates were 9% and 11%, respectively. Compared with male patients, female patients were less likely to receive PCI (62% vs 73%; P < 0.0001) and had a more than 2-fold greater 1-year mortality (22% vs 9%; adjusted HR: 2.1; 95% CI: 1.7-2.7; P < 0.001). Conclusions In this contemporary registry of patients with STEMI in India, female patients were less likely to receive PCI after STEMI and had a higher 1-year mortality compared with male patients. These findings have important public health implications, and further efforts are required to reduce these gaps.
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Affiliation(s)
- Arman Qamar
- Section of Interventional Cardiology & Vascular Medicine, Division of Cardiology, NorthShore University Health System, Evanston, Illinois, USA
| | - Kirtipal Bhatia
- Mount Sinai Heart, Mount Sinai Morningside Hospital, New York, New York, USA
| | - Sameer Arora
- Division of Cardiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Michael Hendrickson
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Puneet Gupta
- Department of Cardiology, Janakpuri Superspeciality Hospital, New Delhi, India
| | - Amber Fatima
- Division of Cardiology, Loyola University Medical Center, Loyola Stritch School of Medicine, Maywood, Illinois, USA
| | - Girish MP
- Department of Cardiology, GB Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Ankit Bansal
- Department of Cardiology, GB Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Vishal Batra
- Department of Cardiology, GB Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Mark J. Ricciardi
- Section of Interventional Cardiology & Vascular Medicine, Division of Cardiology, NorthShore University Health System, Evanston, Illinois, USA
| | - Cindy L. Grines
- Department of Cardiovascular Medicine, Northside Cardiovascular Institute, Atlanta, Georgia, USA
| | - Jamal Yusuf
- Department of Cardiology, GB Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Saibal Mukhopadhyay
- Department of Cardiology, GB Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Sidney C. Smith
- Division of Cardiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Sanjay Tyagi
- Department of Cardiology, GB Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Deepak L. Bhatt
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai Health System, New York, New York, USA
| | - Martha Gulati
- Barbra Streisand Women’s Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA
| | - Mohit D. Gupta
- Department of Cardiology, GB Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
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Premature coronary artery disease, risk factors, clinical presentation, angiography and interventions: Hospital based registry. Indian Heart J 2022; 74:391-397. [PMID: 35995321 DOI: 10.1016/j.ihj.2022.08.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/19/2022] [Accepted: 08/17/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND & AIMS Premature coronary artery disease (CAD) is endemic in India. We performed a study to identify risk factors, clinical presentation, angiographic findings and interventions in premature CAD. METHODS Successive patients who underwent percutaneous intervention (PCI) were enrolled from January 2018 to June 2021. Premature CAD was defined as women 45-59 y and men 40-54 y and very premature as women <45 y and men <40 y. Descriptive statistics are presented. Univariate odds ratio (OR) and 95% confidence intervals (95%CI) were calculated to identify differences in various groups. RESULTS 4672 patients (women 936, men 3736) were enrolled. Premature CAD was in 1238 (26.5%; women 31.9%; men 25.1%) and very premature in 212 (4.5%; women 6.5%, men 4.0%). In premature and very premature vs non-premature CAD, OR (95%CI) for high cholesterol ≥200 mg/dl [women 1.52(1.03-2.25) and 1.59(0.79-3.20); men 1.73(1.38-2.17) and 1.92(1.22-3.03)], non-HDL cholesterol ≥130 mg/dl [women 1.84(1.35-2.52) and 1.32(0.72-2.42); men 1.69(1.43-1.90) and 1.67(1.17-2.34)], LDL cholesterol [men 1.10(0.95-1.25) and 1.04(0.77-1.41)], and tobacco [women 1.40(0.84-2.35) and 2.14(0.95-4.82); men 1.63(1.34-1.98) and 1.27(0.81-1.97)] were higher while hypertension, diabetes and chronic kidney disease were more in non-premature(p < 0.05). Presentation as STEMI was marginally more in women with premature [1.13(0.85-1.51)] and very premature [1.29(0.75-2.22)] CAD and was significantly higher in men [1.35(1.16-1.56) and 1.79(1.29-2.49)]. Location and extent of CAD were not different. CONCLUSIONS In India, a third of CAD patients presenting for coronary intervention have premature disease. Important risk factors are high total and non-HDL cholesterol and tobacco (men) with greater presentation as STEMI. Extent and type of CAD are similar to non-premature CAD indicating severe disease.
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Sex Differences in Acute Coronary Syndromes: A Global Perspective. J Cardiovasc Dev Dis 2022; 9:jcdd9080239. [PMID: 36005403 PMCID: PMC9409655 DOI: 10.3390/jcdd9080239] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 07/19/2022] [Accepted: 07/21/2022] [Indexed: 02/06/2023] Open
Abstract
Despite increasing evidence and improvements in the care of acute coronary syndromes (ACS), sex disparities in presentation, comorbidities, access to care and invasive therapies remain, even in the most developed countries. Much of the currently available data are derived from more developed regions of the world, particularly Europe and the Americas. In contrast, in more resource-constrained settings, especially in Sub-Saharan Africa and some parts of Asia, more data are needed to identify the prevalence of sex disparities in ACS, as well as factors responsible for these disparities, particularly cultural, socioeconomic, educational and psychosocial. This review summarizes the available evidence of sex differences in ACS, including risk factors, pathophysiology and biases in care from a global perspective, with a focus on each of the six different World Health Organization (WHO) regions of the world. Regional trends and disparities, gaps in evidence and solutions to mitigate these disparities are also discussed.
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Mathew A, Hong Y, Yogasundaram H, Nagendran J, Punnoose E, Ashraf S, Fischer L, Abdullakutty J, Pisharody S, Bainey K, Graham M. Sex and Medium-term Outcomes of ST-Segment Elevation Myocardial Infarction in Kerala, India: A Propensity Score–Matched Analysis. CJC Open 2021; 3:S71-S80. [PMID: 34993436 PMCID: PMC8712709 DOI: 10.1016/j.cjco.2021.09.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 09/21/2021] [Indexed: 11/24/2022] Open
Abstract
Background Sex-based differences have been found in outcomes following ST-segment myocardial infarction (STEMI). Studies assessing sex-based differences in STEMI among Indian patients have reported conflicting results. Methods A prospective multicenter registry of consecutive patients with STEMI who presented to percutaneous coronary intervention (PCI)–capable hospitals in the Indian state of Kerala between June 2013 and March 2017 was used to assess 1-year outcomes. The primary endpoint was a composite of major adverse cardiac events (MACE), including death, stroke, nonfatal myocardial infarction, and rehospitalization for heart failure. Outcomes of 2 sex-based propensity score–matched groups were compared. Results We included 3194 patients (19.4% women). Women presenting with STEMI were older, had more traditional cardiovascular risk factors, and were more likely to be classified as living in poverty. After propensity-score matching, women experienced greater incidence of MACE (20.9% vs 14.3%, P < 0.01), primarily driven by increased 1-year mortality (14.3% vs 8.6%, P < 0.01). Women were more likely to experience prehospital delays, compared with men. Although reperfusion rates were similar between the groups, men were more likely than women to undergo reperfusion within the first 12 hours of chest pain onset. Among patients undergoing primary PCI, women were more likely to have delayed PCI than were men (80.2% vs 72.9%, P = 0.03). Procedural characteristics were similar between groups. Conclusions Women in this cohort experienced higher incidence of MACE at 1 year, compared to men, primarily owing to increased mortality. Timeliness of reperfusion appears to be the primary factor impacting differences in outcomes between the 2 groups and may represent an attractive target for quality-improvement initiatives.
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Affiliation(s)
- Anoop Mathew
- Division of Cardiology, University of Alberta Hospital, Edmonton, Alberta, Canada
- Division of Cardiology, Malankara Orthodox Syrian Christian Medical College Hospital, Kolenchery, Kerala, India
- Corresponding author: Dr Anoop Mathew, Division of Cardiology, Department of Medicine, Mazankowski Alberta Heart Institute, 2C2 WMC, 8440 – 112 St, NW, Edmonton, Alberta T6G 2B7, Canada
| | - Yongzhe Hong
- Division of Cardiac Surgery, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - Haran Yogasundaram
- Division of Cardiology, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - Jeevan Nagendran
- Division of Cardiac Surgery, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - Eapen Punnoose
- Division of Cardiology, Malankara Orthodox Syrian Christian Medical College Hospital, Kolenchery, Kerala, India
| | - S.M. Ashraf
- Division of Cardiology, Government Medical College Hospital, Pariyaram, Kerala, India
| | - Louie Fischer
- Division of Cardiology, Malankara Orthodox Syrian Christian Medical College Hospital, Kolenchery, Kerala, India
| | | | - Sunil Pisharody
- Division of Cardiology, Elamkulam Manakkal Sankaran Memorial Co-operative Hospital and Research Centre, Perinthalmanna, Kerala, India
| | - Kevin Bainey
- Division of Cardiology, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - Michelle Graham
- Division of Cardiology, University of Alberta Hospital, Edmonton, Alberta, Canada
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Prasad K, Reddy S S, Kaur J, Rao k R, Kumar S, Kadiyala V, Ram Kashyap J, Panwar G. Gender-based in vivo comparison of culprit plaque characteristics and plaque microstructures using optical coherence tomography in acute coronary syndrome. J Cardiovasc Thorac Res 2021; 13:277-284. [PMID: 35047132 PMCID: PMC8749362 DOI: 10.34172/jcvtr.2021.46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 08/31/2021] [Accepted: 09/24/2021] [Indexed: 12/03/2022] Open
Abstract
Introduction: Women perform worse after acute coronary syndrome (ACS) than men. The reason for these differences is unclear. The aim was to ascertain gender differences in the culprit plaque characteristics in ACS.
Methods: Patients with ACS undergoing percutaneous coronary intervention for the culprit vessel underwent optical coherence tomography (OCT) imaging. Culprit plaque was identified as lipid rich,fibrous, and calcific plaque. Mechanisms underlying ACS are classified as plaque rupture, erosion,or calcified nodule. A lipid rich plaque along with thin-cap fibroatheroma (TCFA) was a vulnerable plaque. Plaque microstructures including cholesterol crystals, macrophages, and microvessels were noted.
Results: A total of 52 patients were enrolled (men=29 and women=23). Baseline demographic features were similar in both the groups except men largely were current smokers (P <0.001). Plaque morphology,men vs. women: lipid rich 88.0% vs. 90.5%; fibrous 4% vs 0%; calcific 8.0% vs. 9.5% (P = 0.64). Of the ACS mechanisms in males versus females; plaque rupture (76.9 % vs. 50 %), plaque erosion (15.4 % vs.40 %) and calcified nodule (7.7 % vs. 10 %) was noted (P = 0.139). Fibrous cap thickness was (50.19 ±11.17 vs. 49.00 ± 10.71 mm, P = 0.71) and thin-cap fibroatheroma (96.2% vs. 95.0%, P = 1.0) in men and women respectively. Likewise no significant difference in presence of macrophages (42.3 % vs. 30%, P = 0.76), microvessels (73.1% vs. 60 %, P = 0.52) and cholesterol crystals (92.3% vs. 80%, P = 0.38).
Conclusion: No significant gender-based in-vivo differences could be discerned in ACS patients’ culprit plaques morphology, characteristics, and underlying mechanisms.
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Affiliation(s)
- Krishna Prasad
- Department of Cardiology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Sreeniavs Reddy S
- Department of Cardiology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
- Department of Cardiology, Government Medical College and Hospital, Sector 32, Chandigarh, 160030, India
| | - Jaspreet Kaur
- Department of Cardiology, Government Medical College and Hospital, Sector 32, Chandigarh, 160030, India
| | - Raghavendra Rao k
- Department of Cardiology, Government Medical College and Hospital, Sector 32, Chandigarh, 160030, India
| | - Suraj Kumar
- Department of Cardiology, Government Medical College and Hospital, Sector 32, Chandigarh, 160030, India
| | - Vikas Kadiyala
- Department of Cardiology, Government Medical College and Hospital, Sector 32, Chandigarh, 160030, India
| | - Jeet Ram Kashyap
- Department of Cardiology, Government Medical College and Hospital, Sector 32, Chandigarh, 160030, India
| | - Garima Panwar
- Department of Cardiology, Government Medical College and Hospital, Sector 32, Chandigarh, 160030, India
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Panda P, Singh NV, Kaur N, Kaur P, Kaur A, Aujla HK, Kaur K, Saini N, Kapoor S, Paul Sharma Y. Delay in Seeking Medical Treatment Among Patients With Acute Coronary Syndrome. Cureus 2021; 13:e17369. [PMID: 34567908 PMCID: PMC8455286 DOI: 10.7759/cureus.17369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2021] [Indexed: 11/28/2022] Open
Abstract
Background Various Indian registries have documented a delay of more than five hours for acute coronary syndrome patients from onset of symptoms to reaching thrombolysis-enabled centres. We conducted this study to evaluate the factors responsible for pre-hospital delay in acute coronary syndrome patients. Methods This was a descriptive cross-sectional study conducted in consecutive acute coronary syndrome patients who reported to the tertiary care medical centre in North India. A standardized tool was used to record the demographic data, socioeconomic status and clinical presentation of patients. All factors which led to pre-hospital delay were noted and the appropriate statistical tests were used for analysis. Results A total of 130 patients (males=93, females=37) were included in the study. The median time at which the acute coronary syndrome patients presented to the thrombolysis and percutaneous coronary intervention enabled centre was 490 minutes (range: 20 - 810 minutes) and 710 minutes (range: 45 - 940 minutes) respectively. The various factors responsible for prehospital delay were rural residence (p-value <0.0001), visit to local dispensary (p-value=0.0023), delay in getting transport (p-value=0.03) and misinterpretation of cardiac symptoms (p-value=0.0004). A significant but weak negative correlation was found between per capita income, decision making time and time taken to receive thrombolytic therapy. Out of a total of 83 ST-elevation myocardial infarction patients, only 46 (51.80%) were thrombolysed. Though 69/83 (83.13%) ST-elevation myocardial infarction patients reached thrombolysis enabled centre directly, only nine (10.84%) were thrombolysed at first medical contact; the rest were transferred to the percutaneous coronary intervention-enabled centre without any prior information. Conclusion Our study concludes that besides socioeconomic and demographic variables, lack of public awareness, well established public transport & health insurance system lead to significant pre-hospital delays and increase the time to revascularization. Besides, judgemental error on the part of medical practitioners in the peripheries also significantly delays thrombolysis in ST-elevation myocardial infarction patients.
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Affiliation(s)
- Prashant Panda
- Cardiology, Postgraduate Institute of Medical Education & Research, Chandigarh, IND
| | - Neena Vir Singh
- Nursing, National Institute of Nursing Education, Postgraduate Institute of Medical Education & Research, Chandigarh, IND
| | - Navjyot Kaur
- Cardiology, Command Hospital Air Force, Bangalore, IND
| | - Prabhjot Kaur
- Nursing, National Institute of Nursing Education, Postgraduate Institute of Medical Education & Research, Chandigarh, IND
| | - Avneet Kaur
- Nursing, National Institute of Nursing Education, Postgraduate Institute of Medical Education & Research, Chandigarh, IND
| | - Harleen Kaur Aujla
- Nursing, National Institute of Nursing Education, Postgraduate Institute of Medical Education & Research, Chandigarh, IND
| | - Khushpreet Kaur
- Nursing, National Institute of Nursing Education, Postgraduate Institute of Medical Education & Research, Chandigarh, IND
| | - Nishtha Saini
- Nursing, National Institute of Nursing Education, Postgraduate Institute of Medical Education & Research, Chandigarh, IND
| | - Shakshi Kapoor
- Nursing, National Institute of Nursing Education, Postgraduate Institute of Medical Education & Research, Chandigarh, IND
| | - Yash Paul Sharma
- Cardiology, Postgraduate Institute of Medical Education & Research, Chandigarh, IND
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Agarwal A, Mohanan PP, Kondal D, Chopra A, Baldridge AS, Davies D, Devarajan R, Unni G, Abdullakutty J, Natesan S, Joseph J, Jayagopal PB, Joseph S, Gopinath R, Prabhakaran D, Huffman MD. Presentation, Management, and In-Hospital Outcomes of Patients with Acute Heart Failure in South India by Sex: A Secondary Analysis of a Prospective, Interrupted Time Series Study. Glob Heart 2021; 16:63. [PMID: 34692388 PMCID: PMC8485866 DOI: 10.5334/gh.1043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 08/25/2021] [Indexed: 11/20/2022] Open
Abstract
Background Sex differences in presentation, management, and outcomes of heart failure (HF) have been observed, but it is uncertain whether these differences exist in South India. Objective We describe sex differences in presentation, management, and in-hospital outcomes in patients hospitalized with HF in South India and explore sex-based differences in the effect of the quality improvement intervention in a secondary analysis of a prospective, interrupted time series study. Methods The Heart Failure Quality Improvement in Kerala (HF QUIK) study evaluated the effect of a quality improvement toolkit on process of care measures and clinical outcomes in patients hospitalized with HF in eight hospitals in Kerala using an interrupted time series design from February 2018 to August 2018. The primary outcome was guideline-directed medical therapy (GDMT) at hospital discharge for patients with HF with reduced ejection fraction (HFrEF). We performed sex-stratified analyses using mixed effect logistic regression models. Results Among 1,400 patients, 536 (38.3%) were female. Female patients were older (69.6 vs. 65 years, p < 0.001), were less likely to have an ischemic etiology of HF (control period: 78.2% vs. 87.5%; intervention period: 83.6% vs. 91.5%; p < 0.05 for both) and were less likely to undergo coronary angiography or percutaneous coronary intervention. The quality improvement intervention had similar effects on the odds of GDMT at discharge in females with HFrEF (adjusted OR 1.79, 95% CI 0.92, 3.47) and males with HFrEF (adjusted OR 1.68, 95% CI 1.07, 2.64, pinteraction = 0.69). Conclusions We observed sex-specific differences in presentation and procedural management of patients with HF but no differences in the effect of the quality improvement intervention on discharge GDMT rates. Both male and female patients with HFrEF remained undertreated in the study intervention period, demonstrating the need for implementation strategies to close the HFrEF treatment gap in South India.
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Affiliation(s)
- Anubha Agarwal
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, US
| | | | - Dimple Kondal
- Centre for Chronic Disease Control, New Delhi, Delhi, IN
| | - Aashima Chopra
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, US
| | - Abigail S. Baldridge
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, US
| | | | - Raji Devarajan
- Centre for Chronic Disease Control, New Delhi, Delhi, IN
| | - Govindan Unni
- Jubilee Mission Medical College and Hospital, Thrissur, Kerala, IN
| | | | | | | | | | - Stigi Joseph
- Little Flower Hospital and Research Centre, Angamaly, Kerala, IN
| | | | - Dorairaj Prabhakaran
- Centre for Chronic Disease Control, New Delhi, Delhi, IN
- The Public Health Foundation of India, Gurugram, Haryana, IN
| | - Mark D. Huffman
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, US
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, US
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, AU
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9
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Khan MY, Pandit S, Guha S, Jadhav U, Rao MS, Gaurav K, Mane A, Dubey A, Bhagwatkar H, Venkataswamy K, Shah S. Demographic profile, clinical characteristics and medical management patterns of Indian coronary artery disease patients: a nationwide urban-based, real-world, retrospective, observational electronic medical record study- report of baseline data. Expert Rev Cardiovasc Ther 2021; 19:769-775. [PMID: 34126829 DOI: 10.1080/14779072.2021.1941872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: This is the first detailed Indian electronic medical record (EMR)-based real-world observational study to understand the clinical characteristics, associated comorbidities/risk factors and treatment(s) of CAD patients across India.Methods: EMR data of adult Indians (aged ≥ 18 years) diagnosed with CAD was retrospectively analyzed.Results: The majority of the participants had stable IHD (93%), were men (68.5% in ACS, 59.8% in stable IHD), most common age group was 40-64 years in ACS (56.6%) and stable IHD (51.4%). Both are common in metros (ACS 52%, 62% stable IHD). There is a high frequency of hypertension (38.2% in ACS, 59% in stable IHD) and diabetes mellitus (32.3% in ACS, 57.6% in stable IHD). Most common treatments are antiplatelet drugs and lipid-lowering drugs (96%).Conclusions: In India, stable IHD is the most prevalent form in vast majority of patients. The patients with CAD are mostly males, are mainly located in metros and majority fall between the age group of 40-64. The major comorbidities are hypertension and diabetes mellitus. Sociodemographic and clinical characteristics for CAD in India may not be similar to what is reported from the west. There is a significant difference in drug usage and adherence to guidelines in India for CAD.
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Affiliation(s)
- Mohammed Yunus Khan
- Department of Cardiology, Dr. Reddy's Laboratories Ltd, Hyderabad, Telangana, India
| | - Sucheta Pandit
- Department of Cardiology, Dr. Reddy's Laboratories Ltd, Hyderabad, Telangana, India
| | - Santanu Guha
- Medical College and Hospital, Kolkata, West Bengal, India
| | | | | | - Kumar Gaurav
- Department of Cardiology, Dr. Reddy's Laboratories Ltd, Hyderabad, Telangana, India
| | - Amey Mane
- Department of Cardiology, Dr. Reddy's Laboratories Ltd, Hyderabad, Telangana, India
| | - Akhilesh Dubey
- Prime Health Clinic and Galaxy Hospital, Jabalpur, India
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10
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Alexander T, Victor SM, Jayakumaran B, Rajan S, Mullasari S A. Sex-related Differences in Outcomes for Patients With ST Elevation Myocardial Infarction (STEMI): A TN-STEMI Program Subgroup Analysis. Heart Lung Circ 2021; 30:1870-1875. [PMID: 34088626 DOI: 10.1016/j.hlc.2021.04.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 02/28/2021] [Accepted: 04/20/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND ST elevation myocardial infarction (STEMI) represents a large proportion of the clinical presentation of coronary artery disease in Indian people. Owing to multiple factors contributing to the sex difference, women with STEMI are thought to have a higher risk of adverse outcomes than men. The aim of this study was to evaluate sex-related differences in the clinical characteristics and prognosis of patients with STEMI within a system of care. METHOD This study was a subgroup analysis of the Tamil Nadu-STEMI (TN-STEMI) program, a multicentre, prospective, observational study of a quality-improvement program studying patients with STEMI at four hub-and-spoke clusters in the southern state of Tamil Nadu, India. In total, 2,420 patients were enrolled between 2012 and 2014, and the data from all four clusters, pre- and postimplementation of integrated STEMI systems, were combined for this analysis, with a 1-year follow-up. RESULTS The mean ± SD age of presentation of female patients (16%) was significantly later (60.1±10.9 years) compared with males (84%; 53.7±12 years). Diabetes was more prevalent in women (35.2% vs 23.8%; p<0.001), as was hypertension (35.2% vs 22.9%; p<0.001). Symptom to first medical contact in female patients was significantly delayed compared with males (193 mins vs 170 mins; p≤0.009). Women had higher mortality, both in hospital (10.4% vs 4.8%; p≤0.001) and at 1 year (26.7% vs 13%; p≤0.001). This pattern was persistent, even in the younger STEMI (<45 years) population (in-hospital: 9.1% vs 3% [p≤0.05]; at 1 year: 18.2% vs 3% [p≤ 0.05]). In the regression model, females had a 1.8 times increased likelihood (p<0.04) of mortality after adjusting for confounders. CONCLUSIONS Among patients with STEMI, women have an unfavourable risk profile and adverse short- and long-term prognoses when compared to men.
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Affiliation(s)
| | | | | | - Sabari Rajan
- Kovai Medical Centre Hospital, Coimbatore, Tamil Nadu, India
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11
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Khraishah H, Alahmad B, Alfaddagh A, Jeong SY, Mathenge N, Kassab MB, Kolte D, Michos ED, Albaghdadi M. Sex disparities in the presentation, management and outcomes of patients with acute coronary syndrome: insights from the ACS QUIK trial. Open Heart 2021; 8:openhrt-2020-001470. [PMID: 33504633 PMCID: PMC7843306 DOI: 10.1136/openhrt-2020-001470] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 12/22/2020] [Accepted: 12/28/2020] [Indexed: 12/18/2022] Open
Abstract
Aims Our aim was to explore sex differences and inequalities in terms of medical management and cardiovascular disease (CVD) outcomes in a low/middle-income country (LMIC), where reports are scarce. Methods We examined sex differences in presentation, management and clinical outcomes in 21 374 patients presenting with acute coronary syndrome (ACS) in Kerala, India enrolled in the Acute Coronary Syndrome Quality Improvement in Kerala trial. The main outcomes were the rates of in-hospital and 30-day major adverse cardiovascular events (MACEs) defined as composite of death, reinfarction, stroke and major bleeding. We fitted log Poisson multivariate random effects models to obtain the relative risks comparing women with men, and adjusted for clustering by centre and for age, CVD risk factors and cardiac presentation. Results A total of 5191 (24.3%) patients were women. Compared with men, women presenting with ACS were older (65±12 vs 58±12 years; p<0.001), more likely to have hypertension and diabetes. They also had longer symptom onset to hospital presentation time (median, 300 vs 238 min; p<0.001) and were less likely to receive primary percutaneous coronary intervention for ST-elevation myocardial infarction (45.9% vs 49.8% of men, p<0.001). After adjustment, women were more likely to experience in-hospital (adjusted relative risk (RR)=1.53; 95% CI 1.32 to 1.77; p<0.001) and 30-day MACE (adjusted RR=1.39; 95% CI 1.23 to 1.57, p<0.001). Conclusion Women presenting with ACS in Kerala, India had greater burden of CVD risk factors, including hypertension and diabetes mellitus, longer delays in presentation, and were less likely to receive guideline-directed management. Women also had worse in-hospital and 30-day outcomes. Further efforts are needed to understand and reduce cardiovascular care disparities between men and women in LMICs.
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Affiliation(s)
- Haitham Khraishah
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Barrak Alahmad
- Environmental Health Department, T H Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Abdulhamied Alfaddagh
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sun Young Jeong
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Njambi Mathenge
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Dhaval Kolte
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Erin D Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Mazen Albaghdadi
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
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12
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Sharma YP, Santosh Vemuri K, Bootla D, Kanabar K, Pruthvi CR, Kaur N, Prasad Nevali K, Panda P, Kasinadhuni G, Uppal L, Mohanty S. Epidemiological profile, management and outcomes of patients with acute coronary syndrome: Single centre experience from a tertiary care hospital in North India. Indian Heart J 2021; 73:174-179. [PMID: 33865514 PMCID: PMC8065348 DOI: 10.1016/j.ihj.2020.11.149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 11/18/2020] [Accepted: 11/20/2020] [Indexed: 12/31/2022] Open
Abstract
Background Cardiovascular disease is the leading cause of death in India. Our aim is to study the clinical, epidemiological profile and in-hospital outcomes of patients presenting with acute coronary syndrome. Methods We did a prospective single center observational study of the 1203 patients presenting with ACS to a tertiary referral center in North India over a period of one year (July 2018–June 2019). Results The mean age of study population was 58.4 ± 12.5 years. STEMI and NSTE-ACS accounted for 69.9% and 31.1% respectively. 62.1% of our patients were from rural background. The median time to hospital admission was 600 min for STEMI patients, thrombolysis was performed in 52% of cases. Cardiogenic shock at presentation was noted in 18%. Coronary angiography and percutaneous coronary intervention were done in 1062 (88.3%) and 733 (60.9%) patients respectively. The overall in-hospital mortality was 7.6%. STEMI patients had higher mortality than NSTE-ACS (8.9% vs 4.5% p < 0.001). Female gender (OR−3.306 C.I. 1.87–5.845), severe MR (OR−4.65, C.I.−1.187–18.18), acute kidney injury (AKI) at admission (OR-5.15, C.I.−2.5–10.63), higher Killip class (class III/IV) (OR−3.378,C.I.−1.292–8.849), AF (OR−3.25, C.I.−1,18–8.92), complete heart block (CHB) (OR−4.44,C.I.−2.09–9.43) and right bundle branch block (RBBB) (OR−2.86, C.I.−1.2–6.8) were significant predictors of in hospital mortality. Conclusions Our study represents the predominance of STEMI as the initial ACS presentation with a considerable delay in first medical contact and higher prevalence of cardiogenic shock (CS). STEMI patients had higher mortality. Female sex, severe MR, AKI, higher Killips class, AF, CHB, RBBB being predictors of high in-hospital mortality in ACS patients.
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Affiliation(s)
- Yash Paul Sharma
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| | - Krishna Santosh Vemuri
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Dinakar Bootla
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| | - Kewal Kanabar
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - C R Pruthvi
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| | - Navjyot Kaur
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Krishna Prasad Nevali
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Prashant Panda
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - G Kasinadhuni
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Lipi Uppal
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Soumitra Mohanty
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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13
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Rehman H, Kalra A, Kochar A, Uberoi AS, Bhatt DL, Samad Z, Virani SS. Secondary prevention of cardiovascular diseases in India: Findings from registries and large cohorts. Indian Heart J 2020; 72:337-344. [PMID: 33189191 PMCID: PMC7670271 DOI: 10.1016/j.ihj.2020.08.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/20/2020] [Accepted: 08/31/2020] [Indexed: 11/30/2022] Open
Abstract
Several registries and quality improvement initiatives have focused on assessing and improving secondary prevention of CVD in India. While the Treatment and Outcomes of Acute Coronary Syndromes in India (CREATE), Indian Heart Rhythm Society-Atrial Fibrillation (IHRS-AF), and Trivandrum Heart Failure (THF) registries are limited to collecting data, the Tamil Nadu-ST-Segment Elevation Myocardial Infarction (TN-STEMI) program was aimed at examining and improving access to revascularization after an ST-elevation myocardial infarction (STEMI). The Acute Coronary Syndromes: Quality Improvement in Kerala (ACS-QUIK) study recruited hospitals from the Kerala ACS registry to assess a quality improvement kit for patients with ACS while the Practice Innovation and Clinical Excellence India Quality Improvement Program (PIQIP) provides valuable data on outpatient CVD quality of care. Collaborative efforts between health professionals are needed to assess further gaps in knowledge and policy makers to utilize new and existing data to drive policy-making.
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Affiliation(s)
- Hasan Rehman
- Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | - Ankur Kalra
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA; Section of Cardiovascular Research, Heart, Vascular and Thoracic Department, Cleveland Clinic Akron General, Akron, OH, USA
| | - Ajar Kochar
- Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA, USA
| | - Angad S Uberoi
- Department of Medicine, Mount Sinai Morningside and Mount Sinai West, New York, NY, USA
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA, USA
| | - Zainab Samad
- Department of Medicine, Section of Cardiology, Aga Khan University, Karachi, Pakistan
| | - Salim S Virani
- Health Policy, Quality & Informatics Program, Michael E. DeBakey Veterans Affairs Medical Center Health Services Research and Development Center for Innovations Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
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14
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Rangaiah SKK, Kaur S, Sidhu NS, Ramesh D, Veerappa K, Manjunath CN. Sex differences in acute coronary syndrome: insights from an observation study in low socio-economic cohort from India. Future Cardiol 2020; 17:329-336. [PMID: 32755322 DOI: 10.2217/fca-2020-0072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To study sex-related differences in acute coronary syndrome (ACS) presentation, management and in-hospital outcomes. Materials & methods: We studied 621 ACS patients (150 women, 471 men) of low socio-economic status from South India from February 2015 to January 2016. Multivariable logistic regression methods were used to assess sex differences in the in-hospital outcomes. Adjudicated major adverse cardiovascular events (MACE) included in-hospital cardiac arrest, cardiogenic shock, heart failure, re-infarction, stroke, major bleeding and mortality. Results & conclusion: Mean age in women was 60.97 ± 11.23 years versus 54.5 ± 10.87 years in men (p < 0.001). Women had higher prevalence of hypertension and diabetes and presented with more non-ST elevation ACS. There were no differences in the use of antiplatelets, statins and other pharmacotherapy except for the higher use of nitrates in women. There were no differences in MACE rates between women and men (15.3 vs 9.6%; adjusted odds ratio: 1.43; CI: 0.76-2.69).
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Affiliation(s)
| | - Sumandeep Kaur
- University College of Nursing, Baba Farid University of Health Sciences, Faridkot, Punjab, India
| | - Navdeep Singh Sidhu
- Department of Cardiology, GGS Medical College & Hospital & Baba Farid University of Health Sciences, Faridkot, Punjab, India
| | - Dwarikaprasad Ramesh
- Department of Cardiology, Vydehi Institute Of Medical Sciences And Research Centre, Bengaluru, Karnataka, India
| | - Kumaraswamy Veerappa
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences & Research, Bengaluru, Karnataka, India
| | - Cholenahally N Manjunath
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences & Research, Bengaluru, Karnataka, India
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15
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Sidhu NS, Rangaiah SKK, Ramesh D, Veerappa K, Manjunath CN. Clinical Characteristics, Management Strategies, and In-Hospital Outcomes of Acute Coronary Syndrome in a Low Socioeconomic Status Cohort: An Observational Study From Urban India. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2020; 14:1179546820918897. [PMID: 32425627 PMCID: PMC7218326 DOI: 10.1177/1179546820918897] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 03/23/2020] [Indexed: 01/24/2023]
Abstract
Background: Coronary artery disease is the leading cause of mortality in India. There is scarcity of data on demographic profile and outcomes of acute coronary syndrome (ACS) in low socioeconomic status (SES) population of India. Objectives: This study was undertaken to determine the clinical presentation, management strategies, and in-hospital outcomes of ACS in low SES population. Methods: We conducted 1-year prospective observational cohort study of ACS patients admitted at Employees State Insurance Corporation unit of our tertiary care cardiac center. Clinical parameters, management strategies, and in-hospital outcomes of 621 patients enrolled during the study period from February 2015 to January 2016 were studied. Results: Mean age of patients was 56.06 ± 11.29 years. Majority (62%) of the patients had ST elevation myocardial infarction (STEMI), whereas Non-ST elevation acute coronary syndrome (NSTE-ACS) was seen in 38% of the patients. Median time from symptom onset to hospital admission was 285 min with wide range from 105 to 1765 min. Coronary angiography was performed in 81% of patient population. Single-vessel disease (SVD) was the most common pattern (seen in 43.3%) of coronary artery involvement with left anterior descending coronary artery (LAD) being the most frequently involved vessel (62.8%). Pharmaco-invasive approach was the preferred strategy. Overall percutaneous coronary intervention (PCI) rates were 59.1% (62.1% in STEMI and 54.2% in NSTE-ACS). Overall in-hospital mortality was 3.2%, being significantly higher in STEMI (4.2%) as compared with NSTE-ACS (1.7%). Conclusions: With implementation of evidence-based pharmacotherapy and interventions, outcomes comparable with developed countries can be achieved even in low SES populations of developing world.
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Affiliation(s)
- Navdeep Singh Sidhu
- Department of Cardiology, Guru Gobind Singh Medical College and Hospital, Faridkot, India
| | | | - Dwarikaprasad Ramesh
- Department of Cardiology, Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, India
| | - Kumaraswamy Veerappa
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, India
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16
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Reda A, Almahmeed W, Dobrecky-Mery I, Huang PH, Juarez-Herrera U, Ranjith N, Sayre T, Urina-Triana M. A Narrative Review and Expert Panel Recommendations on Dyslipidaemia Management After Acute Coronary Syndrome in Countries Outside Western Europe and North America. Adv Ther 2020; 37:1754-1777. [PMID: 32227306 PMCID: PMC7467479 DOI: 10.1007/s12325-020-01302-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Indexed: 11/28/2022]
Abstract
Patients who have experienced an acute coronary syndrome (ACS) are at very high risk of recurrent atherosclerotic cardiovascular disease (CVD) events. Dyslipidaemia, a major risk factor for CVD, is poorly controlled post ACS in countries outside Western Europe and North America, despite the availability of effective lipid-modifying therapies (LMTs) and guidelines governing their use. Recent guideline updates recommend that low-density lipoprotein cholesterol (LDL-C), the primary target for dyslipidaemia therapy, be reduced by ≥ 50% and to < 1.4 mmol/L (55 mg/dL) in patients at very high risk of CVD, including those with ACS. The high prevalence of CVD risk factors in some regions outside Western Europe and North America confers a higher risk of CVD on patients in these countries. ACS onset is often earlier in these patients, and they may be more challenging to treat. Other barriers to effective dyslipidaemia control include low awareness of the value of intensive lipid lowering in patients with ACS, physician non-adherence to guideline recommendations, and lack of efficacy of currently used LMTs. Lack of appropriate pathways to guide follow-up of patients with ACS post discharge and poor access to intensive medications are important factors limiting dyslipidaemia therapy in many countries. Opportunities exist to improve attainment of LDL-C targets by the use of country-specific treatment algorithms to promote adherence to guideline recommendations, medical education and greater prioritisation by healthcare systems of dyslipidaemia management in very high risk patients. Video Abstract
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Affiliation(s)
- Ashraf Reda
- Department of Cardiology, Menoufia University, 127 Mohamed Fareed Street, Babellouk, Cairo, Egypt.
| | - Wael Almahmeed
- Department of Cardiovascular Medicine, Cleveland Clinic, Abu Dhabi, UAE
| | | | - Po-Hsun Huang
- Department of Critical Care Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | | | | | | | - Miguel Urina-Triana
- Cardiology Division, Faculty of Health Sciences, Simón Bolívar University, Barranquilla, Colombia
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17
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Naliganti C, Valupadas C, Akkinepally RR, Eesam S. Evaluation of drug utilization in cardiovascular disease at a teaching and referral hospital in Northern Telangana. Indian J Pharmacol 2019; 51:323-329. [PMID: 31831921 PMCID: PMC6892011 DOI: 10.4103/ijp.ijp_743_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 10/18/2019] [Accepted: 10/12/2019] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES Cardiovascular disease (CVD) is the primary cause of death globally despite the advanced health-care facilities. Extensive disparity exists in pharmacotherapy pattern among CVD patients where rational drug use plays a pivotal role in promoting safety and efficacy. The study focused to evaluate drug utilization using the World Health Organization (WHO) prescribing indicators and defined daily dose (DDD) in patients admitted to a teaching/referral hospital in Northern Telangana. MATERIALS AND METHODS A total of 1120 medical records were analyzed for drug utilization for a period of 7 months. Prescription pattern was assessed using the WHO prescribing indicators and DDD to measure individual drug utilization categorized under anatomical-therapeutic-chemical classification. RESULTS Of the total admissions, 58.57% (55.19 ± 15.19 years) were male and 41.43% (56.64 ± 15.28 years) were female where coronary artery disease was the most common cause of admission followed by cardiomyopathy. Among prescribing indicators, percentage of drugs with generic names was least accounted with 26.86% and 18.95% during hospitalization and discharge, respectively. A mean of 11.55 (hospitalization) and 6.55 (discharge) drugs were prescribed per prescription. Antiplatelet (72.86%) and statin (80.62%) use was predominate during complete therapy. The DDD of furosemide (109.33) was found to be high, followed by atorvastatin (64.6), enalapril (58.44), aspirin (58.14) and clopidogrel (53.2). CONCLUSION Polypharmacy and least use of generic name were observed in the study which may affect the rationality. The use of antiplatelets, statins, and angiotensin-converting enzyme-inhibitors was appropriate, but furosemide overuse is of major concern. Therefore, appropriate prescription writing improvises treatment compliance in the patients, which results in rationality.
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Affiliation(s)
- Chandana Naliganti
- Department of Pharmaceutical Sciences, University College of Pharmaceutical Sciences, Kakatiya University, Warangal, Telangana, India
| | - Chandrasekhar Valupadas
- Department of General Medicine, Kakatiya Medical College, Mahatma Gandhi Memorial Hospital, Warangal, Telangana, India
| | | | - Shivarani Eesam
- Department of Pharmaceutical Sciences, University College of Pharmaceutical Sciences, Kakatiya University, Warangal, Telangana, India
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18
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Gupta R, Khedar RS, Gaur K, Xavier D. Low quality cardiovascular care is important coronary risk factor in India. Indian Heart J 2018; 70 Suppl 3:S419-S430. [PMID: 30595301 PMCID: PMC6309144 DOI: 10.1016/j.ihj.2018.05.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 05/03/2018] [Indexed: 01/12/2023] Open
Abstract
Global Burden of Disease study has reported that cardiovascular and ischemic heart disease (IHD) mortality has increased by 34% in last 25 years in India. It has also been reported that despite having lower coronary risk factors compared to developed countries, incident cardiovascular mortality, cardiovascular events and case-fatality are greater in India. Reasons for the increasing trends and high mortality have not been studied. There is evidence that social determinants of IHD risk factors are widely prevalent and increasing. Epidemiological studies have reported low control rates of hypertension, hypercholesterolemia, diabetes and smoking/tobacco. Registries have reported greater mortality of acute coronary syndrome in India compared to developed countries. Secondary prevention therapies have significant gaps. Low quality cardiovascular care is an important risk factor in India. Package of interventions focusing on fiscal, intersectoral and public health measures, improvement of health services at community, primary and secondary healthcare levels and appropriate referral systems to specialized hospitals is urgently required.
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Affiliation(s)
- Rajeev Gupta
- Eternal Heart Care Centre & Research Institute, Mount Sinai New York Affiliate, Jaipur, India.
| | - Raghubir S Khedar
- Eternal Heart Care Centre & Research Institute, Mount Sinai New York Affiliate, Jaipur, India
| | - Kiran Gaur
- Department of Statistics, SKN Agricultural University, Jobner, Jaipur, India
| | - Denis Xavier
- Department of Pharmacology, St John's Medical College, Bangalore, India
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19
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Khan E, Brieger D, Amerena J, Atherton JJ, Chew DP, Farshid A, Ilton M, Juergens CP, Kangaharan N, Rajaratnam R, Sweeny A, Walters DL, Chow CK. Differences in management and outcomes for men and women with ST‐elevation myocardial infarction. Med J Aust 2018; 209:118-123. [DOI: 10.5694/mja17.01109] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Accepted: 03/08/2018] [Indexed: 12/21/2022]
Affiliation(s)
| | | | | | | | - Derek P Chew
- Flinders Medical Centre, Adelaide, SA
- Flinders University, Adelaide, SA
| | | | | | | | | | | | - Amy Sweeny
- Gold Coast University Hospital, Gold Coast, QLD
| | | | - Clara K Chow
- Westmead Applied Research Centre, University of Sydney, Sydney, NSW
- Westmead Hospital, Sydney, NSW
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Liakos M, Parikh PB. Gender Disparities in Presentation, Management, and Outcomes of Acute Myocardial Infarction. Curr Cardiol Rep 2018; 20:64. [DOI: 10.1007/s11886-018-1006-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Mahajan K, Negi PC, Merwaha R, Mahajan N, Chauhan V, Asotra S. Gender differences in the management of acute coronary syndrome patients: One year results from HPIAR (HP-India ACS Registry). Int J Cardiol 2018; 248:1-6. [PMID: 28942868 DOI: 10.1016/j.ijcard.2017.07.028] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 07/03/2017] [Accepted: 07/10/2017] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Data from high-income countries suggest that women receive less intensive diagnostic and therapeutic management than men for acute coronary syndrome (ACS). There is a paucity of such data in the Indian population, which is 69% rural and prior studies focused mostly on urban populations. The objective of the present study was to identify the gender based differences in ACS management, if any, in a predominantly rural population. METHODS Data from 35 hospitals across Himachal Pradesh covering >90% of state population were collected for one year (July 2015-June 2016). A total of 2118 ACS subjects met inclusion criteria and baseline characteristics, in-hospital treatments and mortality rates were analyzed. RESULTS Women constituted less than one-third of ACS population. Women were older compared to men and were more likely to present with NSTEMI/UA. Misinterpretation of initial symptoms and late presentation were also common in women. Fewer women received optimal guideline based treatment and PCI (0.9% vs 4.2%, p<0.01). Compare to men, women more often had Killip class >1 (27.3% vs 20.4%, p<0.01) and higher in-hospital mortality (8.5% vs 5.6%, p=0.009). On multivariate analysis the association between female gender and mortality was attenuated (adjusted odds ratio [OR]=1.36 [0.77-2.38]). CONCLUSION The present study from India, is the first of its kind to evaluate the gender based differences among ACS patients, in a predominantly rural population. Our analysis demonstrates a significant gender based difference between symptom awareness and delay in presentation, management and in-hospital outcome. Further studies are warranted across other parts of country to investigate this gender disparity.
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Affiliation(s)
- Kunal Mahajan
- Department of Cardiology, Indira Gandhi Medical College (IGMC), Shimla, 171001, Himachal Pradesh, India.
| | - Prakash Chand Negi
- Department of Cardiology, Indira Gandhi Medical College (IGMC), Shimla, 171001, Himachal Pradesh, India.
| | - Rajeev Merwaha
- Department of Cardiology, Indira Gandhi Medical College (IGMC), Shimla, 171001, Himachal Pradesh, India
| | - Nitin Mahajan
- Department of Pediatrics, Washington University in St Louis, 63110, MO, USA
| | - Vivek Chauhan
- Department of Medicine, Rajender Prasad Medical College (RPMC), Tanda, 176001, Himachal Pradesh, India
| | - Sanjeev Asotra
- Department of Cardiology, Indira Gandhi Medical College (IGMC), Shimla, 171001, Himachal Pradesh, India
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Ndrepepa G. Gender disparities in acute coronary syndromes - The way things stand in the sub-Himalayan state of Himachal Pradesh in Northern India. Int J Cardiol 2017; 248:82-83. [DOI: 10.1016/j.ijcard.2017.08.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 08/14/2017] [Indexed: 11/17/2022]
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Guha S, Sethi R, Ray S, Bahl VK, Shanmugasundaram S, Kerkar P, Ramakrishnan S, Yadav R, Chaudhary G, Kapoor A, Mahajan A, Sinha AK, Mullasari A, Pradhan A, Banerjee AK, Singh BP, Balachander J, Pinto B, Manjunath CN, Makhale C, Roy D, Kahali D, Zachariah G, Wander GS, Kalita HC, Chopra HK, Jabir A, Tharakan J, Paul J, Venogopal K, Baksi KB, Ganguly K, Goswami KC, Somasundaram M, Chhetri MK, Hiremath MS, Ravi MS, Das MK, Khanna NN, Jayagopal PB, Asokan PK, Deb PK, Mohanan PP, Chandra P, Girish CR, Rabindra Nath O, Gupta R, Raghu C, Dani S, Bansal S, Tyagi S, Routray S, Tewari S, Chandra S, Mishra SS, Datta S, Chaterjee SS, Kumar S, Mookerjee S, Victor SM, Mishra S, Alexander T, Samal UC, Trehan V. Cardiological Society of India: Position statement for the management of ST elevation myocardial infarction in India. Indian Heart J 2017; 69 Suppl 1:S63-S97. [PMID: 28400042 PMCID: PMC5388060 DOI: 10.1016/j.ihj.2017.03.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
| | - Rishi Sethi
- King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Saumitra Ray
- Vivekananda Institute of Medical Sciences, Kolkata, West Bengal, India
| | - Vinay K Bahl
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | | | - Prafula Kerkar
- Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | | | - Rakesh Yadav
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | | | - Aditya Kapoor
- Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Ajay Mahajan
- Lokmanya Tilak Municipal Medical College & General Hospital, Mumbai, Maharashtra, India
| | | | | | | | - Amal Kumar Banerjee
- Institute of Post Graduate Medical Education & Research and Memorial Hospital, Kolkata, West Bengal, India
| | - B P Singh
- Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - J Balachander
- Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India
| | - Brian Pinto
- Holy family Hospital, Mumbai, Maharashtra, India
| | - C N Manjunath
- Sri Jaydeva Institute of Cardiovascular Sciences & Research, Bangaluru, Karnataka, India
| | | | | | - Dhiman Kahali
- BM Birla Heart Research Center, Kolkata, West Bengal, India
| | | | - G S Wander
- Hero DMC Heart Institute, Ludhiana, Punjab, India
| | - H C Kalita
- Assam Medical College, Dibrugarh, Assam, India
| | | | - A Jabir
- Lisie Hospital, Kochi, Kerala, India
| | - JagMohan Tharakan
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Justin Paul
- Madras Medical College, Chennai, Tamil Nadu, India
| | - K Venogopal
- Pushpagiri Institute of Medical Sciences, Tiruvalla, Kerala, India
| | - K B Baksi
- Belle Vue Clinic, Kolkata, West Bengal, India
| | | | - Kewal C Goswami
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | | | - M K Chhetri
- IPGMER & SSKM Hospital, Kolkata, West Bengal, India
| | | | - M S Ravi
- Madras Medical College, Chennai, Tamil Nadu, India
| | | | | | | | - P K Asokan
- The Fatima Hospital, Calicut, Kerala, India
| | - P K Deb
- ESI Hospital, Manicktala, Kolkata, West Bengal, India
| | - P P Mohanan
- Westfort Hi-Tech Hospital, Thrissur, Kerala, India
| | | | - Col R Girish
- Command Hospital, Central Command, Lucknow, India
| | - O Rabindra Nath
- Apollo Gleneagles Heart Institute, Kolkata, West Bengal, India
| | | | - C Raghu
- Prime Hospitals, Hyderabad, India
| | | | | | - Sanjay Tyagi
- GB Pant Institute of Post Graduate Medical Education & Research, New Delhi, India
| | | | - Satyendra Tewari
- Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | | | | | | | - S S Chaterjee
- Indra Gandhi Institute of Cardiology, Patna, Bihar, India
| | - Soumitra Kumar
- Vivekananda Institute of Medical Sciences, Kolkata, West Bengal, India
| | | | | | - Sundeep Mishra
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | | | | | - Vijay Trehan
- Indo-US Super Speciality Hospital, Hyderabad, India
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Du X, Patel A, Li X, Wu Y, Turnbull F, Gao R. Treatment and outcomes of acute coronary syndromes in women: An analysis of a multicenter quality improvement Chinese study. Int J Cardiol 2017; 241:19-24. [PMID: 28363686 DOI: 10.1016/j.ijcard.2017.03.090] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 02/05/2017] [Accepted: 03/20/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Variations in care and outcomes by sex in patients with acute coronary syndrome (ACS) have been reported worldwide. The aims of this study are to describe ACS management according to sex in China and the effects of a quality improvement program in Chinese male and female ACS patients. METHODS AND RESULTS Clinical Pathways for Acute Coronary Syndromes - Phase 2 (CPACS-2) was a cluster randomized trial to test whether a clinical pathways-based intervention would improve ACS management in China. The study enrolled 15,141 hospitalized patients [4631 (30.6%) were women] from 75 hospitals throughout China between October 2007 and August 2010. The intervention included clinical pathway implementation and performance measurement using standardized indicators with 6 monthly audit-feedback cycles. Eight key performance indicators reflecting in hospital management of ACS were measured. After adjustment for differences in patient characteristics and comorbidities at presentation, women were significantly less likely to undergo coronary angiography when indicated (RR 0.88 [0.85 to 0.92], P<0.001), less likely to receive guideline recommended medical therapies at discharge (RR 0.94 [0.91 to 0.98], P=0.003) and more likely to be hospitalized for shorter (mean difference -0.42 [-0.73 to -0.12] days, P=0.007). However, in-hospital clinical outcomes did not differ by sex. There was no evidence of heterogeneity in the relative effects of the quality improvement initiative by sex. CONCLUSIONS Sex disparities were apparent in some key quality of care indicators for patients with suspected with ACS presenting to hospitals in China. The beneficial effect of the quality improvement program was consistent in women and men. CLINICAL TRIAL REGISTRATION http://www.anzctr.org.au/default.aspx. Unique identifier: ACTRN12609000491268.
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Affiliation(s)
- Xin Du
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China; The George Institute for Global Health at Peking University Health Science Center, Beijing, China.
| | - Anushka Patel
- The George Institute for Global Health, University of Sydney, Sydney, Australia
| | - Xian Li
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
| | - Yangfeng Wu
- Peking University Clinical Research Institute, Beijing, China; Peking University School of Public Health, Beijing, China; Peking University People's Hospital, Beijing, China
| | - Fiona Turnbull
- The George Institute for Global Health, University of Sydney, Sydney, Australia
| | - Runlin Gao
- The Department of Cardiology, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
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Iyengar SS, Gupta R, Ravi S, Thangam S, Alexander T, Manjunath CN, Keshava R, Patil CB, Sheela A, Sawhney JPS. Premature coronary artery disease in India: coronary artery disease in the young (CADY) registry. Indian Heart J 2016; 69:211-216. [PMID: 28460769 PMCID: PMC5414957 DOI: 10.1016/j.ihj.2016.09.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 09/14/2016] [Accepted: 09/29/2016] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Coronary artery disease (CAD) occurs at younger age in India but only a limited number of studies have evaluated risk factors and management status. This is a multisite observational registry to assess risk factors and treatment patterns in young patients presenting with acute coronary syndrome (ACS) and stable ischemic heart disease (IHD). METHODS We recruited 997 young patients (men <55, women <65y) presenting with ACS or stable IHD successively at 22 centers across India. Details of baseline risk factors and management status were obtained. Descriptive statistics are reported. RESULTS Mean age of participants was 49.1±8y, 72% were men and 68% had ACS. Family history of CAD was in 50%, diabetes 44%, hypertension 49%, history of dyslipidemia 11%, smoking/tobacco use 39%, and sedentary habits in 20%. 1.3% had "possible familial hypercholesterolemia". Metabolic risk factors (high BMI, diabetes and hypertension) were significantly greater in women (p<0.01). Women were older at diagnosis of CAD and presented more often with non-ST elevation ACS. In the study cohort antiplatelet use was in 85%, beta-blockers 38%, statins 63% and ACE inhibitors/ARBs in 41% while in ACS patients it was 80.5%, 54.6%, 80.8% and 40.8%, respectively. 35.9% patients underwent percutaneous coronary intervention while coronary bypass surgery was performed in 10.4%. CONCLUSIONS Conventional risk factors including family history continue to play a pivotal role in premature CAD in Indians. Women have more of metabolic risk factors, present at a later age and have non-ST elevation ACS more often. There is a need to focus on improving use of evidence-based drug therapies and interventions.
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Affiliation(s)
| | - Rajiv Gupta
- Eterna Heart Care Centre and Research Institute, Jaipur, India
| | - Sandhya Ravi
- Lotus Clinical Research Academy, Bangalore, India
| | | | | | - C N Manjunath
- Sri Jaideva Institute of Cardiovascular Sciences and Research, Bangalore, India
| | | | - C B Patil
- St Philomena Hospital, Bangalore, India
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Sharma KK, Mathur M, Lodha S, Sharma SK, Sharma N, Gupta R. Study of differences in presentation, risk factors and management in diabetic and nondiabetic patients with acute coronary syndrome. Indian J Endocrinol Metab 2016; 20:354-358. [PMID: 27186553 PMCID: PMC4855964 DOI: 10.4103/2230-8210.179990] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To compare clinical characteristics, treatment, and utilization of evidence-based medicines at discharge from hospital in acute coronary syndrome (ACS) patients with or without diabetes at a tertiary care cardiac center in India. METHODS We performed an observational study in consecutive patients discharged following management of ACS. We obtained demographic details, comorbid conditions, and cardiovascular risk factors, physical and biochemical parameters, and management. Descriptive statistics are reported. RESULTS We enrolled 100 patients (diabetics = 28) with mean age of 59.0 ± 10.8 years (diabetics 59.3 ± 11.6, nondiabetics 58.9 ± 8.5). Forty-nine patients had ST-elevation myocardial infarction (STEMI) (diabetics = 14, 28.7%) while 51 had nonSTEMI/unstable angina (diabetics = 14, 27.4%) (P = nonsignificant). Among diabetics versus nondiabetics there was greater prevalence (%) of hypertension (78.6% vs. 44.4%), obesity (25.0% vs. 8.3%), abdominal obesity (85.7% vs. 69.4%) and sedentary activity (89.2% vs. 77.8%), and lower prevalence of smoking/tobacco use (10.7% vs. 25.0%) (P < 0.05). In STEMI patients 28 (57.1%) were thrombolysed (diabetes 17.8% vs. 31.9%), percutaneous coronary interventions (PCI) was in 67.8% diabetics versus 84.7% nondiabetics and coronary bypass surgery in 21.4% versus 8.3%. At discharge, in diabetics versus nondiabetics, there was similar use of angiotensin converting enzyme inhibitors (67.9% vs. 69.4%) and statins (100.0% vs. 98.6%) while use of dual antiplatelet therapy (85.7% vs. 95.8%) and beta-blockers (64.3% vs. 73.6%) was lower (P < 0.05). CONCLUSIONS Diabetic patients with ACS have greater prevalence of cardiometabolic risk factors (obesity, abdominal obesity, and hypertension) as compared to nondiabetic patients. Less diabetic patients undergo PCIs and receive lesser dual anti-platelet therapy and beta-blockers.
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Affiliation(s)
- Krishna Kumar Sharma
- Department of Pharmacology, LBS College of Pharmacy, Jaipur, Rajasthan, India
- Department of Clinical Research, Fortis Escorts Hospital, Jaipur, Rajasthan, India
| | - Mukul Mathur
- Department of Pharmacology, SMS Medical College, Jaipur, Rajasthan, India
| | - Sailesh Lodha
- Department of Endocrinology, Fortis Escorts Hospital, Jaipur, Rajasthan, India
| | | | - Niharika Sharma
- Department of Medicine, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
| | - Rajeev Gupta
- Department of Clinical Research, Fortis Escorts Hospital, Jaipur, Rajasthan, India
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Sex Differences in the Presentation, Diagnosis, and Management of Acute Coronary Syndromes: Findings From the Kerala-India ACS Registry. Glob Heart 2015; 10:273-80. [PMID: 26410401 DOI: 10.1016/j.gheart.2015.06.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 04/29/2015] [Accepted: 06/08/2015] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Previous literature from high-income countries has repeatedly shown sex differences in the presentation, diagnosis, and management of acute coronary syndromes (ACS), with women having atypical presentations and undergoing less aggressive diagnostic and therapeutic measures. However, much less data exist evaluating sex differences in ACS in India. OBJECTIVES This study sought to evaluate sex differences in the diagnosis, management, and treatment of patients with ACS in Kerala, India. METHODS The Kerala ACS Registry collected data from 25,748 consecutive ACS admissions (19,923 men and 5,825 women) from 125 hospitals in the Indian state of Kerala from 2007 to 2009. This study evaluated the association between sex differences in presentation, in-hospital management, and discharge care with in-hospital mortality and in-hospital major adverse cardiovascular events (defined as death, reinfarction, stroke, heart failure, or cardiogenic shock). RESULTS Women with ACS were older than men with ACS (64 vs. 59, p < 0.001) and were more likely to have a history of previous myocardial infarction (16% vs. 14%, p < 0.001). Inpatient diagnostics and management and discharge care were similar between sexes. No significant differences between men and women in the outcome of death (odds ratio [OR]: 1.05, 95% confidence interval [CI]: 0.80 to 1.38) or in the composite outcome of death, reinfarction, stroke, heart failure, or cardiogenic shock (OR: 0.99, 95% CI: 0.79 to 1.25) were seen after adjustment for possible confounding factors. CONCLUSIONS In Kerala, even though women with ACS were older and more likely to have previous myocardial infarction, there were no significant differences in in-hospital and discharge management, in-hospital mortality, or major adverse cardiovascular events between sexes. Whether these results apply to other parts of India or acute presentations of other chronic diseases in low- and middle-income countries warrants further study.
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Prevalence of comorbidities and their impact on hospital management and short-term outcomes in Vietnamese patients hospitalized with a first acute myocardial infarction. PLoS One 2014; 9:e108998. [PMID: 25279964 PMCID: PMC4184812 DOI: 10.1371/journal.pone.0108998] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 08/30/2014] [Indexed: 12/19/2022] Open
Abstract
Background Cardiovascular disease is one of the leading causes of morbidity and mortality in Vietnam. We conducted a pilot study of Hanoi residents hospitalized with a first acute myocardial infarction (AMI) at the Vietnam National Heart Institute in Hanoi for purposes of describing the prevalence of cardiovascular (CVD) and non-CVD comorbidities and their impact on hospital management, in-hospital clinical complications, and short-term mortality in these patients. Methods The study population consisted of 302 Hanoi residents hospitalized with a first AMI at the largest tertiary care medical center in Hanoi in 2010. Results The average age of study patients was 66 years and one third were women. The proportions of patients with none, any 1, and ≥ 2 CVD comorbidities were 34%, 42%, and 24%, respectively. Among the CVD comorbidities, hypertension was the most commonly reported (59%). There were decreasing trends in the proportion of patients who were treated with effective cardiac medications and coronary interventions as the number of CVD comorbidities increased. Patients with multiple CVD comorbidities tended to develop acute clinical complications and die at higher rates during hospitalization compared with patients with no CVD comorbidities (Odds Ratio: 1.40; 95% Confidence Interval: 0.40–4.84). Conclusions Our data suggest that patients with multiple cardiac comorbidities tended to experience high in-hospital death rates in the setting of AMI. Full-scale surveillance of Hanoi residents hospitalized with AMI at all Hanoi hospitals is needed to confirm these findings. Effective strategies to manage Vietnamese patients hospitalized with AMI who have multiple comorbidities are warranted to improve their short-term prognosis.
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Abstract
Ischemic heart disease (IHD) is the greatest single cause of mortality and loss of disability-adjusted life years worldwide, and a substantial portion of this burden falls on low- and middle-income countries (LMICs). Deaths from IHD and acute coronary syndrome (ACS) occur, on average, at younger ages in LMICs than in high-income countries, often at economically productive ages, and likewise frequently affect the poor within LMICs. Although data about ACS in LMICs are limited, there is a growing literature in this area and the research gaps are being steadily filled. In high-income countries, decades of investigation into the risk factors for ACS and development of behavioral programs, medications, interventional procedures, and guidelines have provided us with the tools to prevent and treat events. Although similar tools can be, and in fact have been, implemented in many LMICs, challenges remain in the development and implementation of cardiovascular health promotion activities across the entire life course, as well as in access to treatment for ACS and IHD. Intersectoral policy initiatives and global coordination are critical elements of ACS and IHD control strategies. Addressing the hurdles and scaling successful health promotion, clinical and policy efforts in LMICs are necessary to adequately address the global burden of ACS and IHD.
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Affiliation(s)
- Rajesh Vedanthan
- From the Department of Medicine, Division of Cardiology, Zena and Michael A. Wiener Cardiovascular Institute and Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, Icahn School of Medicine at Mount Sinai, New York, NY (R.V., V.F.); Department of Biology and School of Medicine, Stanford University, Palo Alto, CA (B.S.); and Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain (V.F.)
| | - Benjamin Seligman
- From the Department of Medicine, Division of Cardiology, Zena and Michael A. Wiener Cardiovascular Institute and Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, Icahn School of Medicine at Mount Sinai, New York, NY (R.V., V.F.); Department of Biology and School of Medicine, Stanford University, Palo Alto, CA (B.S.); and Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain (V.F.)
| | - Valentin Fuster
- From the Department of Medicine, Division of Cardiology, Zena and Michael A. Wiener Cardiovascular Institute and Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, Icahn School of Medicine at Mount Sinai, New York, NY (R.V., V.F.); Department of Biology and School of Medicine, Stanford University, Palo Alto, CA (B.S.); and Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain (V.F.).
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Sex differences in clinical characteristics, hospital management practices, and in-hospital outcomes in patients hospitalized in a Vietnamese hospital with a first acute myocardial infarction. PLoS One 2014; 9:e95631. [PMID: 24752383 PMCID: PMC3994106 DOI: 10.1371/journal.pone.0095631] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Accepted: 03/28/2014] [Indexed: 11/21/2022] Open
Abstract
Background Cardiovascular disease is one of the leading causes of morbidity and mortality in Vietnam. We conducted a pilot study of Hanoi residents hospitalized with acute myocardial infarction (AMI) at the Vietnam National Heart Institute in Hanoi. The objectives of this observational study were to examine sex differences in clinical characteristics, hospital management, in-hospital clinical complications, and mortality in patients hospitalized with an initial AMI. Methods The study population consisted of 302 Hanoi residents hospitalized with a first AMI at the largest tertiary care medical center in Hanoi in 2010. Results The average age of study patients was 66 years and one third were women. Women were older (70 vs. 64 years) and were more likely than men to have had hyperlipidemia previously diagnosed (10% vs. 2%). During hospitalization, women were less likely to have undergone percutaneous coronary intervention (PCI) compared with men (57% vs. 74%), and women were more likely to have developed heart failure compared with men (19% vs. 10%). Women experienced higher in-hospital case-fatality rates (CFRs) than men (13% vs. 4%) and these differences were attenuated after adjustment for age and history of hyperlipidemia (OR: 2.64; 95% CI: 1.01, 6.89), and receipt of PCI during hospitalization (OR: 2.09; 95% CI: 0.77, 5.09). Conclusions Our pilot data suggest that among patients hospitalized with a first AMI in Hanoi, women experienced higher in-hospital CFRs than men. Full-scale surveillance of all Hanoi residents hospitalized with AMI at all Hanoi medical centers is needed to confirm these findings. More targeted and timely educational and treatment approaches for women appear warranted.
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