Management quality indicators and in-hospital mortality among acute coronary syndrome patients admitted to tertiary hospitals in Ethiopia: prospective observational study

Abstract

Background Acute coronary syndrome (ACS) remains the leading cause of cardiovascular disease mortality and morbidity worldwide. While the management quality measures and clinical outcomes of patients with ACS have been evaluated widely in developed countries, inadequate data are available from sub-Saharan Africa countries. So, this study aimed to assess the clinical profiles, management quality indicators, and in-hospital outcomes of patients with ACS in Ethiopia. Methods A Prospective observational study was conducted at two tertiary hospitals in Ethiopia from March 2018 to November 2018. The primary outcome of the study was in-hospital mortality. Data were analyzed using SPSS version 23.0. Multivariable cox-regression was conducted to identify predictors of time to in-hospital mortality. Variable with p -value < 0.05 was considered statistically significant. Results Among 181 ACS patients enrolled, about (61%) were presented with ST-elevation myocardial infarction (STEMI). The mean age of the study participant was 55.8 ± 11.9 years and 62.4% were males. The use of guideline-directed medications within 24 h of hospitalization were sub-optimal (57%) [Dual antiplatelet (73%), statin (74%), beta-blocker (67%) and ACEI (61%)]. Only (7%) ACS patients received the percutaneous coronary intervention (PCI). Discharge aspirin and statin were high (> 90%) while other medications were sub-optimal (< 80%). The all-cause in-hospital mortality rate was 20.4% and the non-fatal MACE rate was 25%. Rural residence (AHR: 3.64, 95% CI: 1.81–7.29), symptom onset to hospital arrival > 12 h (AHR: 4.23, 95% CI: 1.28–13.81), and Cardiogenic shock (AHR: 7.20, 95% CI: 3.55–14.55) were independent predictors of time to in-hospital death among ACS patients. Conclusion In the present study, the use of guideline-directed in-hospital medications was sub-optimal. The overall in-hospital mortality rate was unacceptably high and highlights the urgent need for national quality-improvement focusing on timely initiation of evidence-based medications, reperfusion therapy, and strategies to reduce pre-hospital delay.

Clinical Features and Treatment Outcome of Patients with Acute Coronary Syndrome Admitted to SPHMMC, Addis Ababa: A 3 Years Retrospective Study

“…In this study, the mean age of ACS patients who presented to the ED was 54.65 ± 14.45 years. This was comparable with other studies in developing world like Gulf RACE registry (56.4±13years) [8], Indian study (56.06±11.29years) [9], the African INTERHEART study (54.3±11.3years) [10] and with other study from Ethiopia such as a multicenter study done at St. Peter's hospital and Jimma University (55.8±11.9 years) [11]. It was also found to be five years lower than that of the study done at Ayder Hospital in Mekelle, Ethiopia(59.12±12.98years) [12] and significantly older than a study done in Dakar, Senegal(34±1.9years) [13].…”

Management and 30-Day Mortality of Acute Coronary Syndrome in a Resource-Limited Setting: Insight From Ethiopia. A Prospective Cohort Study

“…The use of guideline-directed in-hospital and discharge medications such as aspirin, second antiplatelet (clopidogrel), statins, beta-blockers, and ACEIs was almost comparable to that of other studies (17,18,21,24,30). However, as we have described in our previous study (14), a timely initiation of these guidelinedirected medications still needs improvement. During the first 24 h of hospital admission, patients presenting with STEMI more likely received guideline-directed medications compared to those who presented with NSTE-ACS.…”

“…ACS was diagnosed by treating cardiologists based on the third universal definition of myocardial infarction (13). Patients who died before evaluation and confirmation of ACS diagnosis, readmitted patients (enrolled previously), those who declined informed consent, and those unable to attend the 30-day follow-up were excluded from this study, as previously described (14). Therefore, the patient profiles in the present findings share similarities with previously published articles of the same project.…”

Optimal Medical Therapy for Secondary Prevention of Acute Coronary Syndrome: A Retrospective Study from a Tertiary Hospital in Sudan

“…The study showed that the median age of patients was 60 years, males were dominated, hypertension and diabetes mellitus patients were the common risk factors, and these findings were similar to previous Sudanese studies. 2 , 17 The mean age in the present study was higher than studies conducted in neighboring countries, 18 , 19 and significantly lower than the European population. 20 About clinical diagnosis of ACS, 58.4%, 22.5%, or 19.1% of patients in this study were diagnosed with STEMI, UA, or NSTEMI, respectively, which was consistent with the previous studies.…”

“…13 , 14 Moreover, the study showed that 3.1% of patients died before hospital discharge, which was much lower than previously published reports from Egypt and Ethiopia. 18 …”