Structure, Process, and Mortality Associated with Acute Coronary Syndrome Management in Guatemala's National
José Antonio Cornejo-Guerra1,2,3, Magda Isabel Ramos-Castro1,4, Mariana Gil-Salazar1
1Universidad de San Carlos de Guatemala, Guatemala.
Insights
Guatemala faces critical gaps in acute coronary syndrome (ACS) care, with low reperfusion rates and limited access to essential treatments like percutaneous coronary intervention (PCI). This highlights significant challenges in the national healthcare system
Area of Science:
- Cardiology
- Public Health
- Health Services Research
Background:
- Acute coronary syndromes (ACS) are a major cause of mortality in Guatemala.
- The country lacks a national policy and standard of care for ACS management.
- This study evaluates the quality of care for ACS within Guatemala's national healthcare system.
Purpose of the Study:
- To identify factors influencing ACS outcomes in Guatemala.
- To assess the quality of care for ACS using the Donabedian health model.
- To highlight deficiencies in the national healthcare system's response to ACS.
Main Methods:
- An observational, multicentre, prospective national registry (ACS-Gt study) was conducted.
- 109 adult ACS patients from six hospitals across Guatemala's National Healthcare System were enrolled.
- Statistical analyses included chi-square, Student's t-test, and Mann-Whitney U tests (p<0.05 significance).
Main Results:
- The study included 109 patients, predominantly male (68%), hypertensive (49.5%), and diabetic (45.9%).
- Only 59% of STEMI patients received fibrinolysis; no primary PCI was performed.
- Reperfusion success was 65%, with significant delays and only 8.3% receiving optimal in-hospital therapy, leading to 20.4% in-hospital mortality.
Conclusions:
- Guatemalan healthcare system exhibits poor access to ACS pharmacological treatment and low reperfusion rates.
- There is a lack of primary, urgent, or rescue PCI, and recommended timeframes for treatment are not met.
- Limited resources are inefficiently utilized, contributing to poor ACS outcomes and high mortality.
Background:
Acute coronary syndromes (ACS) include ST-segment elevation myocardial infarction (STEMI), non-ST-segment elevation myocardial infarction (NSTEMI), and unstable angina (UA). The leading cause of mortality in Guatemala is acute myocardial infarction (AMI) and there is no established national policy nor current standard of care.
Objective:
Describe the factors that influence ACS outcome, evaluating the national healthcare system's quality of care based on the Donabedian health model.
Methods:
The ACS-Gt study is an observational, multicentre, and prospective national registry. A total of 109 ACS adult patients admitted at six hospitals from Guatemala's National Healthcare System were included. These represent six out of the country's eight geographic regions. Data enrolment took place from February 2020 to January 2021. Data was assessed using chi-square test, Student's t-test, or Mann-Whitney U test, whichever applied. A p-value < 0.05 was considered statistically significant.
Results:
One hundred and nine patients met inclusion criteria (80.7% STEMI, 19.3% NSTEMI/UA). The population was predominantly male, (68%) hypertensive (49.5%), and diabetic (45.9%). Fifty-nine percent of STEMI patients received fibrinolysis (alteplase 65.4%) and none for primary Percutaneous Coronary Intervention (pPCI). Reperfusion success rate was 65%, and none were taken to PCI afterwards in the recommended time period (2-24 hours). Prognostic delays in STEMI were significantly prolonged in comparison with European guidelines goals. Optimal in-hospital medical therapy was 8.3%, and in-hospital mortality was 20.4%.
Conclusions:
There is poor access to ACS pharmacological treatment, low reperfusion rate, and no primary, urgent, or rescue PCI available. No patient fulfilled the recommended time period between successful fibrinolysis and PCI. Resources are limited and inefficiently used.
More Related Videos
18:11A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis
Published on: December 28, 2012
06:16Signal Acquisition, Score Interpretation, and Economics of a Non-Invasive Point-of-Care Test for Coronary Artery Disease
Published on: August 9, 2024
Related Concept Videos
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:26Acute Coronary Syndrome V: Nursing Management
01:20Angina V: Nursing Management
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:26Angina IV: Management
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations