Optimal in-hospital and discharge medical therapy in acute coronary syndromes in Kerala: Results from the Kerala acute coronary syndrome registry

Mark D. Huffman*, Dorairaj Prabhakaran, Adangapuram Kurien Abraham, Mangalath Narayanan Krishnan, Asokan Cheviri Nambiar, Padinhare Purayil Mohanan

*Corresponding author for this work

Research output: Contribution to journalArticle

31 Scopus citations

Abstract

Background-In-hospital and postdischarge treatment rates for acute coronary syndrome (ACS) remain low in India. However, little is known about the prevalence and associations of the package of optimal ACS medical care in India. Our objective was to define the prevalence, associations, and impact of optimal in-hospital and discharge medical therapy in the Kerala ACS Registry of 25 718 admissions. Methods and Results-We defined optimal in-hospital ACS medical therapy as receiving the following 5 medications: aspirin, clopidogrel, heparin, β-blocker, and statin. We defined optimal discharge ACS medical therapy as receiving all of the above therapies except heparin. Comparisons by optimal versus nonoptimal ACS care were made via Student t test for continuous variables and X2 test for categorical variables. We created random effects logistic regression models to evaluate the association between Global Registry of Acute Coronary Events risk score variables and optimal in-hospital or discharge medical therapy. Optimal in-hospital and discharge medical care were delivered in 40% and 46% of admissions, respectively. Wide variability in both in-hospital and discharge medical care was present, with few hospitals reaching consistently high (>90%) levels. Patients receiving optimal in-hospital medical therapy had an adjusted odds ratio (95% confidence interval)=0.93 (0.71, 1.22) for in-hospital death and an adjusted odds ratio (95% confidence interval)=0.79 (0.63, 0.99) for major adverse cardiovascular event rates. Patients who received optimal in-hospital medical care were far more likely to receive optimal discharge care (adjusted odds ratio [95% confidence interval] = 10.48 [9.37, 11.72]). Conclusions-Strategies to improve in-hospital and discharge medical therapy are needed to improve local process-of-care measures and ACS outcomes in Kerala.

Original languageEnglish (US)
Pages (from-to)436-443
Number of pages8
JournalCirculation: Cardiovascular Quality and Outcomes
Volume6
Issue number4
DOIs
StatePublished - Jul 2013

Keywords

  • Acute coronary syndrome
  • Health policy and outcome research
  • Registries

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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