Rationale, design, methodology and hospital characteristics of the first gulf acute heart failure registry [gulf care]

There is paucity of data on heart failure [HF] in the Gulf Middle East. The present paper describes the rationale, design, methodology and hospital characteristics of the first Gulf acute heart failure registry [Gulf CARE]. Gulf CARE is a prospective, multicenter, multinational registry of patients >18 year of age admitted with diagnosis of acute HF [AHF]. The data collected included demographics, clinical characteristics, etiology, precipitating factors, management and outcomes of patients admitted with AHF. In addition, data about hospital readmission rates, procedures and mortality at 3 months and 1-year follow-up were recorded. Hospital characteristics and care provider details were collected. Data were entered in a dedicated website using an electronic case record form. A total of 5005 consecutive patients were enrolled from February 14, 2012 to November 13, 2012. Forty-seven hospitals in 7 Gulf States [Oman, Saudi Arabia, Yemen, Kuwait, United Gulf Emirates, Qatar and Bahrain] participated in the project. The majority of hospitals were community hospitals [46%; 22/47] followed by non-University teaching [32%; 15/47 and University hospitals [17%]. Most of the hospitals had intensive or coronary care unit facilities [93%; 44/47] with 59% [28/47] having catheterization laboratory facilities. However, only 29% [14/47] had a dedicated HF clinic facility. Most patients [71%] were cared for by a cardiologist. Gulf CARE is the first prospective registry of AHF in the Middle East, intending to provide a unique insight into the demographics, etiology, management and outcomes of AHF in the Middle East. HF management in the Middle East is predominantly provided by cardiologists. The data obtained from this registry will help the local clinicians to identify the deficiencies in HF management as well as provide a platform to implement evidence based preventive and treatment strategies to reduce the burden of HF in this region

Clinical pathways for non-ST elevation acute coronary syndrome in Oman: an Oman heart association protocol for hospital quality improvement initiative

In 2012, Oman Heart Association [OHA] published its own guidelines for the management of patients with unstable angina/ non-ST-elevation myocardial infarction, the aim was not to be comprehensive but rather simplified and practical in order to reduce the gap between the long comprehensive guidelines and our actual practice. However, we still feel that the busy registrars and residents need simpler and direct clinical pathways or protocol to be used in the emergency departments, coronary care units and in the wards. Clinical pathways are now one of the main tools used to manage the quality in healthcare concerning the standardization of care processes. It has been shown that their implementation reduces the variability in clinical practice and improves outcomes in acute care

Characteristics, management, and in-hospital outcomes of diabetic acute coronary syndrome patients in Oman

To determine clinical characteristics, management, and in-hospital outcomes of diabetic and non-diabetic patients admitted with acute coronary syndrome [ACS] in Oman. Data were analyzed from 1583 consecutive patients admitted to various hospitals in Oman with ACS from May 8 to June 6, 2006, and from January 29 to June 29, 2007, as part of the Gulf RACE [Registry of Acute Coronary Events]. The ACS patients were stratified into those with and without diabetes mellitus. In this study, 588 [37%] patients were diabetic with a mean age of 59 years and included more female than male diabetics [43% versus 33%; p<0.001]. Diabetic patients were more likely to present with unstable angina [55% versus 44%; p<0.001] and less likely to present with ST elevation myocardial infarction [20% versus 27%; p=0.001]. Both groups received ACS treatment equally; however, diabetic patients were more likely to be treated with glycoprotein IIb/IIIa antagonists and angiotensin-converting enzyme inhibitors or receptor blockers. Diabetic patients experienced more recurrent ischemia [12% versus 8%; p=0.043], heart failure [29% versus 23%; p=0.009], cardiogenic shock [7.5% versus 4.6%; p=0.018], and ventilator requirement [7.3% versus 4.1%; p=0.006]. When adjusted for age and gender, diabetes status was an independent risk factor of in-hospital mortality in ACS patients [adjusted odd ratio, 1.68; 95% confidence interval, 1.02-2.77; p=0.042]. Diabetic ACS patients have different clinical characteristics and poorer outcomes. Present treatment strategies are not sufficient to counter the adverse impact of diabetes. More effective and evidence-based therapeutic strategies should be identified and used in diabetic ACS patients