Utilization of evidence-based therapy for acute coronary syndrome in high-income and low/middle-income countries

Avi Shimony, Sonia M. Grandi, Louise Pilote, Lawrence Joseph, Jennifer O'Loughlin, Gilles Paradis, Stéphane Rinfret, Nizal Sarrafzadegan, Nasreen Adamjee, Rakesh Yadav, Habib Gamra, Jean G. Diodati, Mark J. Eisenberg

Research output: Contribution to journalArticlepeer-review

17 Scopus citations

Abstract

Limited data exist regarding the management of patients with acute coronary syndrome (ACS) in high-income countries compared with low/middle-income countries. We aimed to compare in-hospital trends of revascularization and prescription of medications at discharge in patients with ACS from high-income (Canada and United States) and low/middle-income (India, Iran, Pakistan, and Tunisia) countries. Data from a double-blind, placebo-controlled, randomized trial investigating the effect of bupropion on smoking cessation in patients after an enzyme-positive ACS was used for our study. A total of 392 patients, 265 and 127 from high-income and from low/middle-income countries, respectively, were enrolled. Patients from high-income countries were older, and were more likely to have diagnosed hypertension and dyslipidemia. During the index hospitalization, patients from high-income countries were more likely to be treated by percutaneous coronary intervention (odds ratio [OR] 19.7, 95% confidence interval [CI] 10.5 to 37.0). Patients with ST elevation myocardial infarction from high-income countries were more often treated by primary percutaneous coronary intervention (OR 16.3, 95% CI 6.3 to 42.3) in contrast with thrombolytic therapy (OR 0.24, 95% CI 0.14 to 0.41). Patients from high-income countries were also more likely to receive evidence-based medications at discharge (OR 2.32, 95% CI 1.19 to 4.52, a composite of aspirin, clopidogrel, and statin). In conclusion, patients with ACS in low/middle-income countries were less likely to be revascularized and to receive evidence-based medications at discharge. Further studies are needed to understand the underutilization of procedures and evidence-based medications in low/middle-income countries.

Original languageEnglish
Pages (from-to)793-797
Number of pages5
JournalAmerican Journal of Cardiology
Volume113
Issue number5
DOIs
StatePublished - 1 Mar 2014
Externally publishedYes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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