Utilizations and perceptions of emergency medical services by patients with ST-segments elevation acute myocardial infarction in Abu Dhabi: a multicenter study

Background: data on the use of emergency medical services [EMS] by patients with cardiac conditions in the Gulf region are scarce, and prior studies have suggested underutilization. Patient perception and knowledge of EMS care is critical to proper utilization of such services

Objectives: to estimate utilization, knowledge, and perceptions of EMS among patients with ST-elevation myocardial infarction [STEMI] in the Emirate of Abu Dhabi

Methods: we conducted a multicenter prospective study of consecutive patients admitted with STEMI in four government?operated hospitals in Abu Dhabi. Semi?structured interviews were conducted with patients to assess the rationale for choosing their prehospital mode of transport and their knowledge of EMS services

Results: of 587 patients with STEMI [age 51 +/- 11 years, male 95%], only 15% presented through EMS, and the remainder came via private transport. Over half of the participants [55%] stated that they did not know the telephone number for EMS. The most common reasons stated for not using EMS were that private transport was quicker [40%] or easier [11%]. A small percentage of participants [7%] did not use EMS because they did not think their symptoms were cardiac?related or warranted an EMS call. Stated reasons for not using EMS did not significantly differ by age, gender, or primary language of the patients

Conclusions: EMS care for STEMI is grossly underutilized in Abu Dhabi. Patient knowledge and perceptions may contribute to underutilization, and public education efforts are needed to raise their perception and knowledge of EMS

Physician perceptions and recommendations about pre-hospital emergency medical services for patients with ST-elevation acute myocardial infarction in Abu Dhabi

Introduction: Physician perceptions about emergency medical services [EMS] are important determinants of improving pre-hospital care for cardiac emergencies. No data exist on physician attitudes towards EMS care of patients with ST-Elevation Myocardial Infarction [STEMI] in the Emirate of Abu Dhabi

Objectives: To describe the perceptions towards EMS among physicians caring for patients with STEMI in Abu Dhabi

Methods: We surveyed a convenience sample of physicians involved in the care of patients with STEMI [emergency medicine, cardiology, cardiothoracic surgery and intensive care] in four government facilities with 24/7 Primary PCI in the Emirate of Abu Dhabi. Surveys were distributed using dedicated email links, and used 5-point Likert scales to assess perceptions and attitudes to EMS

Results: Of 106 physician respondents, most were male [82%], practicing in emergency medicine [47%] or cardiology [44%] and the majority [63%] had been in practice for >10 years. Less than half of the responders [42%] were "Somewhat Satisfied" [35%] or "Very Satisfied" [7%] with current EMS level of care for STEMI patients. Most respondents were "Very Likely" [67%] to advise a patient with a cardiac emergency to use EMS, but only 39% felt the same for themselves or their family. Most responders were supportive [i.e. "Strongly Agree"] of the following steps to improve EMS care: 12-lead ECG and telemetry to ED by EMS [69%], EMS triage of STEMI to PCI facilities [65%], and activation of PCI teams by EMS [58%]. Only 19% were supportive of pre-hospital fibrinolytics by EMS. There were no significant differences in the responses among the specialties

Conclusions: Most physicians involved in STEMI care in Abu Dhabi are very likely to advise patients to use EMS for a cardiac emergency, but less likely to do so for themselves or their families. Different specialties had concordant opinions regarding steps to improve pre-hospital EMS care for STEMI

Gulf implantable cardioverter-defibrillator registry: rationale, methodology, and implementation

Background: The implantable cardioverter-defibrillator [ICD] is effective in the prevention of sudden cardiac death in high-risk patients. Little is known about ICD use in the Arabian Gulf. We designed a study to describe the characteristics and outcomes of patients receiving ICDs in the Arab Gulf region

Methods: Gulf ICD is a prospective, multi-center, multinational, and observational study. All adult patients 18 years or older, receiving a de novo ICD implant and willing to sign a consent form will be eligible. Data on baseline characteristics, ICD indication, procedure and programing, in-hospital, and 1-year outcomes will be collected. Target enrollment is 1500 patients, which will provide adequate precision across a wide range of expected event rates

Results: Fifteen centers in six countries are enrolling patients [Saudi Arabia, United Arab Emirates, Kuwait, Oman, Bahrain, and Qatar]. Two-thirds of the centers have dedicated electrophysiology laboratories, and in almost all centers ICDs are implanted exclusively by electrophysiologists. Nearly three-quarters of the centers reported annual ICD implant volumes of

Conclusions: Gulf ICD is the first prospective, observational, multi-center, and multinational study of the characteristics and, the outcomes of patients receiving ICDs in the Arab Gulf region. The study will provide valuable insights into the utilization of and outcomes related to ICD therapy in the Gulf region

Short-term effects of ivabradine in patients with chronic stable ischemic heart disease

Ivabradine is a novel selective If current inhibitor with anti-ischemic and antianginal activity. To assess the effect of the selective If current inhibitor ivabradine on heart rate, angina pectoris, and functional capacity in stable patients with chronic coronary artery disease on maximally tolerated medical therapy. Consecutive patients from the out-patient cardiology clinic with stable coronary artery disease documented by coronary angiography were included. Patients had to be on maximally tolerated medical therapy with beta-blockers, angiotensin-converting enzyme inhibitors or receptor blockers [ACE-I or ARB], antiplatelets, statins, nitrates, and anti-metabolics with a baseline heart rate of at least 70 beats per minute. All patients underwent assessment of angina [Canadian Cardiovascular Society Angina Class: CCS I to IV] and functional capacity [using a validated self-administered questionnaire], at baseline and after 4 months of ivabradine therapy. Twenty patients were enrolled [mean age 47 +/- 7 years, all male, 60% with hypertension, 30% with diabetes mellitus]. Patients were on optimal medical regimen of aspirin [100%], beta-blocker [100%], statins [100%], clopidogrel [90%], nitrates [35%], anti-metabolics [90%], and ACE-I or ARB [95%]. At baseline, the majority of patients [90%] were in CCS class II-IV. All patients were started on ivabradine 5 mg twice daily, and in 12 patients the dose was increased to 7.5 mg twice daily. After 4 months of treatment, the heart rate was significantly reduced from an average of 82 +/- 8 to 68 +/- 6 bpm [P<0.001]. The reduction in heart rate was accompanied by a significant improvement in functional capacity [score 3.5 +/- 0.9 to 4.7 +/- 0.7, P <0.001] and angina classification; at baseline 10% of the patients were in CCS class I compared to 50% after 4 months of therapy [P =0.01]. No symptomatic bradycardia was reported with ivabradine. The addition of ivabradine to optimal medical therapy in patients with stable coronary artery disease is associated with significant improvement in anginal symptoms and functional capacity

Prospective observational studies of the management and outcomes in patients with atrial fibrillation: a systematic review

Atrial fibrillation [AF] is a major global public health problem. Observational studies are necessary to understand patient characteristics, management, and outcomes of this common arrhythmia. Accordingly, our objective was to describe the current status of published prospective observational studies of AF. MEDLINE and EMBASE [to June 2012] and reference lists of eligible studies were searched for English-language prospective observational registries of AF [n >/= 100 and follow-up >/= 6 months]. Two reviewers independently extracted data. Disagreements were resolved by consensus. Eight prospective studies enrolled a total of 17,924 patients with AF [total 41,306 patient-years of exposure; follow-up 11 months to 9.9 years]. The majority of subjects were enrolled in Europe [74%] or North America [21%], and 0.3% had rheumatic AF. The most consistently reported comorbidities were diabetes mellitus [range 5-18%], hypertension [39-68%], heart failure [5-58%], and prior stroke [4-17%]. Three studies did not report all the variables necessary to calculate the currently recommended stroke risk assessment score, and no study reported all the variables required to calculate a recently validated bleeding risk score. The most consistently reported management features were oral anticoagulation [32-64%] and aspirin [28-61%] use. Calcium channel blockers were less frequently used than other rate controlling agents, and digoxin was most common in the single study from Africa [63%]. Total mortality was reported in all studies, while data on stroke/systemic embolism, hospitalizations, and major hemorrhage rates were not always reported. Current literature on real-world management of AF is relatively limited with inadequate data to allow detailed comparisons among reports. Data on rheumatic AF and from Africa and the developing world in general are sparse.

Should we screen asymptomatic diabetics for coronary artery disease?

Diabetes is a major worldwide healthcare problem and cardiovascular diseases are the most common causes of mortality and morbidity in the type 2 diabetic population with Coronary artery disease [CAD] accounting for 65% to 80% of deaths in diabetic patients. It has been suggested that screening asymptomatic diabetics could identify early coronary artery disease which may improve their outcomes. In this review, we summarize the data regarding screening asymptomatic diabetics and provide recommendations based on the evidence

Catheter ablation for atrial fibrillation: an update

Atrial fibrillation [AF] is a common and increasingly prevalent orrhythmia associated with a significant burden on morbidity, mortality and healthcare expenditure. Catheter ablation for AF has evolved into a viable therapeutic option in select patients with symptomatic AF. Its development has been particularly promising given the suboptimal efficacy and risks associated with current rhythm control strategies. It offers an attractive alternative to maintaining sinus rhythm without the serious side effects associated with anti-arrhythmic drugs. Its superior efficacy over antiarrhythmic drugs in maintaining sinus rhythm has been demonstrated in several randomized controlled trials. Further studies are required to assess the long-term effects of catheter ablation for AF, especially its effect on stroke and mortality. The present paper will summarize the rationale for considering catheter ablation for AF, the evidence for its efficacy from controlled clinical trials, and future directions of research. Over the past decade, catheter oblation for atrial fibrillation [AF] has rapidly evolved as a viable tool for managing AF in select patients. This rapid evolution was driven by a pressing need for novel approaches to AF therapy, an enhanced understanding of the triggers and etiology of AF, and development of advanced catheter and imaging technologies. The present paper will discuss the rationale and evidence-base for utilizing catheter ablation in the management of AF