Objectives This novel, pilot study aimed to assess the estimated prevalence of high on-treatment platelet reactivity (HPR) in Trinidad and Tobago.MethodsPatients (n=40) who were awaiting elective percutaneous coronary intervention on maintenance dual antiplatelet therapy (DAPT) with aspirin 81 mg daily and clopidogrel 75 mg or loaded at least 48 hours prior were recruited. Platelet reactivity with the VerifyNow P2Y12 assay (Accriva Diagnostics, San Diego, California, USA) was assessed prior to cardiac catheterisation.Results60.7% (17/28) of the South Asian (Indo-Trinidadians) patients had HPR, whereas 14.3% (1/7) of Africans and 40% (2/5) of mixed ethnicity had HPR. There was a significant association between HPR (P2Y12 reaction units >208) and ethnicity with South Asians (Indo-Trinidadians) (OR 5.4; 95% CI 1.18 to 24.66, p=0.029).ConclusionsThis pilot study serves to introduce the preliminary observation that the estimated prevalence of HPR is considerably higher within the heterogeneous population in Trinidad at 50% as compared with predominantly Caucasian studies. Furthermore, the HPR is significantly higher in South Asians (Indo-Trinidadians) (>60% of patients) which has severe clinical repercussions considering the cardiovascular disease pandemic. Clopidogrel may not be a satisfactory or optimal antiplatelet agent in this subgroup, and therefore, another more potent antiplatelet such as ticagrelor should be used instead. Further large-scale studies are imperative to confirm these findings. (Funded by the University of the West Indies, St. Augustine; POINT ClinicalTrials.gov number, NCT03667066.)

The incidence of left ventricular (LV) thrombi in the setting of an anterior myocardial infarction has declined significantly since the advent of primary percutaneous coronary intervention coupled with contemporary antithrombotic strategies in ST-segment elevation myocardial infarctions (STE-ACS). Despite oral anticoagulation with the currently accepted, standard-of-care vitamin K antagonist, warfarin, major bleeding complications still arise. Rivaroxaban is a novel, direct oral factor X anticoagulant that has several advantageous properties, which can attenuate bleeding risk. We present a case in which a patient successfully underwent a 3-month course of rivaroxaban in addition to his dual antiplatelet regimen of aspirin and ticagrelor for his STE-ACS and LV thrombus with resultant complete dissolution.

Background This study aimed to screen cardiovascular patients for depressive symptoms at a tertiary centre in Trinidad and Tobago; and to determine any significant associations amongst patients’ demographics, comorbidities, and cardiovascular medications with depressive symptoms. Methods In this observational, cross-sectional study, patients (n = 1203) were randomly selected from the cardiology outpatient clinics at the Eric Williams Medical Sciences Complex. After meeting selection criteria, informed consent was obtained, and patients were administered a case report form, which included the Patient Health Questionnaire-9 (PHQ-9). Descriptive analyses included frequency, percentage and summary statistics. Inferential analyses included 95% confidence intervals (CIs), independent sample t-test, Fisher’s exact test, Chi-square test, and multivariate logistic regression. Results The study had a 96% respondent rate, whereby the average age was 62 years old. Slightly less than half were male, and 52.5% were female. Over 90 % of the sample had cardiovascular disease (CVD). One-quarter of the sample had a PHQ-9 score of ≥10, with almost one-fifth having no depressive symptoms. Females, lower levels of education and income were all found to be statistically significant at risk for depressive symptoms (all p-values < 0.001). Comorbidities associated with depressive symptoms included hypertension, prior cerebrovascular events, chronic kidney disease, and chronic obstructive pulmonary disease with odds ratios (ORs) and 95% confidence intervals (CIs) of OR 1.988 (CI 1.414–2.797), OR 1.847 (CI 1.251–2.728), OR 1.872 (CI 1.207–2.902) and OR 1.703 (CI 1.009–2.876) respectively. Only the cardiovascular medication of ticagrelor was found to be significantly associated with depressive symptoms (p-value < 0.001). Conclusions Twenty-five percent of screened cardiovascular patients displayed significant depressive symptoms with a PHQ-9 ≥ 10. This study also highlights the importance of implementing a multidisciplinary approach to managing cardiovascular disease and screening for depressive symptoms in this subpopulation. Further studies are required to validate these findings. Trial Registration ClinicalTrials.gov number, NCT03863262. This trial was retrospectively registered on 20th February 2019.

Background: The aim of the study is to assess the degree of CV health literacy in the Trinidadian public health sector and to identify any factors associated with it. Methods: The descriptive, cross-sectional study was conducted at a single, public health care tertiary hospital, cardiology outpatient clinic located in northern-central Trinidad. Participants: A total of 420 persons were approached, of whom, 390 agreed to participate. Participants included all sexes and ethnicities. The study only excluded patients who declined participation and those younger than 18 years of age. Primary and secondary outcome measures: The primary endpoints were the mean score and percentage of correctly answered items, and percentages of modest and high levels of knowledge. Secondary endpoints were the proportion of participants with tertiary or above level education. Results: The study had a response rate of approximately 93%. The domain of “risk factors” had the most correct responses (69.4%), whereas “medical knowledge” reflected the least correct (57.7%) responses. The overall mean score was 19.7 out of the 30-question questionnaire. This translated to a 65.8% correct response rate. The percentage of participants who scored less than 70% and greater than 70% of the questions correctly were 56.2% and 43.8% respectively. The study participants were found to be more knowledgeable about CVD if they reported “tertiary education,” OR 2.572 (95% CI 1.508-4.387) (p = .001).Conclusions: Respondents displayed a modest level of knowledge and key deficiencies were identified which could potentially translate into suboptimal CV clinical outcomes. The study underscores the paramount importance of establishing comprehensive educational interventions to improve overall CVD literacy in Trinidad and Tobago. Further studies are required to confirm and validate these findings.

Background: This study aims to quantitatively estimate the level of cardiovascular medication adherence in Trinidad’s public health sector and to determine any correlating factors. The study was of a descriptive, cross-sectional design which was performed at a cardiology outpatient clinic located at a northern-central public health care tertiary hospital in Trinidad during the period November 2016 to June 2017. Methods: 595 persons in total were asked to participate, of whom, 535 agreed. Patients that were younger under the age of 18 years and those that declined participation were excluded from the study. Primary endpoints were the percentages of low, medium and high cardiovascular medication adherence. Secondary endpoints were the comorbidity prevalence rates and prevalence of cardiovascular medications prescribed to patients. Results: In total, 595 individuals were asked to participate in the study; of whom, 535 agreed with a resultant 90% response rate. The mean age of the sample population was 63.5 years. Approximately half of the respondents were females and over 75% had only primary and secondary level of education combined as well as a monthly income of <$5,000 Trinidad and Tobago dollars (TTD). Almost 75% of study participants had low and medium adherence levels, and conversely a little more than one-quarter had high adherence levels. There were no significant associations between adherence and any other demographic factor, however there was near-significance with respect to adherence and level of education (p= 0.061). Conclusions: Patients generally displayed a limited level of cardiovascular medication adherence which is likely to translate into a higher rate of cardiovascular events with their potentially devastating sequalae. This study underscores the imperative need of implementing comprehensive interventions to accentuate cardiovascular medication adherence in Trinidad and Tobago. Further comparable studies with reference national data are required to validate these findings.