Presentation and outcome of patients with acute coronary syndromes in eastern Nepal
Nikesh Raj Shreshta1, Sandeep Basnet, Rupak Bhandari
1Department of Cardiology, BP Koirala Institute of Health Sciences, Dharan, Nepal.
Insights
Ischemic heart disease (IHD) and acute coronary syndrome (ACS) are rising in developing nations. Many patients in Nepal present late, face financial barriers to treatment, and experience high in-hospital mortality rates, highlighting a need for improved healthcare access and interventions.
Area of Science:
- Cardiology
- Public Health
- Developing Country Health
Background:
- Ischemic heart disease (IHD) poses a growing threat in developing countries, exacerbated by urbanization and limited access to evidence-based treatments.
- Acute coronary syndrome (ACS) represents a significant burden, with increasing incidence in regions like Eastern Nepal.
Purpose of the Study:
- To evaluate the characteristics, treatment delays, management, and in-hospital outcomes of patients admitted with acute coronary syndrome (ACS) at a tertiary care center in Eastern Nepal.
- To identify barriers to optimal medical care for ACS patients in this setting.
Main Methods:
- A retrospective analysis of 153 consecutive patients admitted with ACS between January 1 and December 31, 2008.
- Data collection included patient demographics, risk factors, educational status, symptom onset to admission time, treatment received, and in-hospital mortality.
Main Results:
- ST-elevation myocardial infarction (STEMI) accounted for 38% of ACS cases, followed by unstable angina (UA) at 44% and non-ST-elevation myocardial infarction (NSTEMI) at 18%.
- A significant delay in presentation was observed, with 33% of patients arriving more than two days after symptom onset.
- Despite thrombolysis being available for STEMI within 24 hours, only 53% received it due to financial constraints, contributing to a 17% in-hospital mortality for STEMI patients and 14% for all ACS patients.
Conclusions:
- A small fraction of ACS patients in Eastern Nepal access hospital care, often presenting late and facing financial hurdles for optimal management.
- Improving public awareness, enhancing referral and transport systems, providing financial aid, and establishing on-site interventional cardiology services are crucial for better ACS patient outcomes.
Background:
The burden of ischemic heart disease (IHD) in developing countries is on the rise, due to urbanisation, industrialisation and the low availability of evidence based therapies and interventions.
Aims And Objectives:
Data was collected on consecutive patients admitted with acute coronary syndrome (ACS), from 1st January to 31st December 2008, to a tertiary care centre in eastern Nepal. Final diagnosis, risk factors, educational status, time delays, treatment and in-hospital outcomes were evaluated.
Results:
A total of 153 patients with ACS were admitted in 2008: 58 with ST elevation myocardial infarction (STEMI) (38%), 28 with non-ST elevation myocardial infarction (NSTEMI) (18%) and 67 with unstable angina (UA) (44%). 40% of patients with STEMI presented within 12 hours of symptom onset. Most patients presented late and 33% of them presented after 2 days or more. Over half the patients were not literate. Due to the unavailability of percutaneous coronary intervention (PCI) at the centre, thrombolysis with Streptokinase was considered for patients presenting with STEMI up to 24 hours after symptom onset. However, due to financial constraints, only 53% of patients in this broadened time window actually received thrombolytic treatment. The in-hospital mortality was 14% for all patients with ACS, and 17% for the patients with STEMI.
Conclusions:
Only a small proportion of patients with ACS in Eastern Nepal are admitted to hospital, and those who are often arrive late, or cannot afford optimal medical management. Awareness, better referral and transport facilities, financial support for the needy, and the availability of on-site coronary angiography and angioplasty for selected patients should contribute to treat more ACS patients and improve their prognosis.
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