A comparison of practice patterns for acute myocardial infarction between hospitals in Canada and India
Insights
This study compared acute myocardial infarction (AMI) care in India and Canada. While Indian patients were younger with more diabetes, treatment patterns were similar once patients reached the hospital.
Area of Science:
- Cardiology
- Public Health
- Comparative Health Systems
Background:
- Cardiovascular disease presents a growing health challenge in India.
- Effective treatments for acute myocardial infarction (AMI) reduce mortality.
- Comparing AMI management between India and Canada can highlight practice differences.
Purpose of the Study:
- To compare risk factors, presentation, and in-hospital management of AMI patients in Indian and Canadian hospitals.
- To identify disparities in acute myocardial infarction (AMI) care delivery.
- To evaluate the utilization of evidence-based therapies for AMI.
Main Methods:
- Retrospective chart review of patients with acute myocardial infarction (AMI).
- Comparison of patient demographics, risk factors, symptom onset to hospital arrival times, and in-hospital treatment delays.
- Analysis of the use of thrombolytic therapy, aspirin, beta-blockers, and ACE inhibitors.
Main Results:
- Indian AMI patients were younger and had higher rates of diabetes but lower rates of prior angina compared to Canadian patients.
- Symptom onset to hospital arrival was significantly longer in India (330 min) than in Canada (101 min).
- In-hospital delay for thrombolytic therapy was greater in Canada (70.5 min) than in India (30 min), with similar appropriate use of key medications in both countries.
Conclusions:
- Risk factors and presentation patterns for acute myocardial infarction (AMI) differ between Indian and Canadian populations.
- Despite delays in presentation, in-hospital management and use of guideline-directed medical therapies for AMI are comparable between the studied Indian and Canadian hospitals.
- Further research into reducing pre-hospital delays in India is warranted.
Abstract:
The increasing burden of cardiovascular disease in India, and the established efficacy of mortality-reducing therapies in acute myocardial infarction (AMI) served as the impetus to compare the management practices of AMI in an Indian hospital and a similar hospital in Canada. A retrospective chart review in each hospital was conducted to identify differences in risk factors, presentation, and acute in-hospital management in patients with AMI. Indian patients were younger (47 +/- 9 years versus 54 +/- 8 years), more likely to have a history of diabetes (21/87 versus 6/69) and less likely to have a previous history of angina (5/87 versus 22/69) compared to Canadian patients (all p < 0.001). The delay from symptom onset to hospital arrival was greater in Bangalore, India (median time 330 min versus 101 min, p < 0.001), yet the in-hospital delay in receiving thrombolytic therapy was greater in Hamilton, Canada (70.5 min in Hamilton versus 30 min in Bangalore, p < 0.0001). There was similarity and appropriate use of thrombolytic therapy, aspirin, beta-blockers and angiotensin-converting enzyme (ACE) inhibitors in both centres. The pattern of presentation and risk factors differ in Indian and Canadian patients. However, once patients present, the patterns of practice appear to be similar.
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