The UP-Philippine General Hospital acute coronary events at the emergency room registry (UP PGH-ACER)

OBJECTIVES: This study pilots the creation of a clinical registry for all patients admitted for Acute Coronary Syndromes(ACS) at the Philippine General Hospital (PGH) Emergency Room (ER). METHODS: This is a single-institution prospective observational study including all patients >18 years old admitted from September to October 2011 with suspected acute coronary syndromes. Abstraction of chart information using a data collection form was done. Patient's clinical data, medications received, and quality of care indicators were noted. The primary study outcome measure is the completeness of chart data, quality indicators such as door-to-ECG time and door-to-needle time, and the clinical profile of patients with ACS. RESULTS: Thirty patients were included, with equal numbers of males females, and a mean age of 59 years old. There were equal numbers of patients with STEMI (43%) and NSTEMI (43%). The most common risk factor was hypertension (72.4%) followed by smoking (34.48%). Around 20% are diabetics, and 31% have known lipid abnormalities or are on lipid-lowering agents. Around one third of the patients have had previous admissions for acute coronary events. Only two patients had angiographically confirmed CAD. The majority of patients assessed to have acute coronary syndromes (26 patients) were Killip Class I. Only one was cardiogenic shock upon admission. Temporal information such as time of first physician contact and time of drug administration was not available in more than half of the cases. While there is a high rate of physician compliance to guideline recommended therapies, temporal quality indicators sch as door-to-ECG time (2 hours) and door-to-needle time (3.5 hours) remain substandard. The rest of the patients presented beyond 12 hours of chest pain onset and were already chest pain free. Among those who were eligible for thrombolysis, 67% received thrombolytic therapy with streptokinase. No patient was given thrombolytic agent within 30 minutes upon admission to the emergency department. No patient underwent cardiac catheterization as the primary means of revascularization. Hence, door-to-balloon time could not be determined. CONCLUSION: A standardized ACS pathway for adequate documentation of information is necessary for a complete and effective clinical registry for ACS must be set in place. Establishment of an efficient clinical registry must be a joint effort of all services involved in the care for these patients. Proper documentation in clinical charts of patients admitted at the PGH-ER needs to be improved. The quality indicators such as door-to-ECG and door-to-needle time were remarkably above the guideline recommended targets. The compliance for class 1 medications among patients admitted for ACS during the time of the study was optimal.

Smoking burden in the Philippines

BACKGROUND: The 2nd National Nutrition and Health Survey (NNHeS II) was conducted in 2008 to measure the prevalence of lifestyle-related diseases and risk factors among adult Filipinos 20 years or older. One of the risk factors measured was smoking. METHODS: The survey used a stratified multi-stage sampling design and covered the 17 regions of the country. The clinical component included Filipino adults 20 years or older. Data was collected using health questionaires; anthropometric measurements were made, and blood examinations performed on all participants. The prevalence of smoking was determined. RESULTS: A total of 7,700 subjects were included in the survey. The over-all prevalence of current smokers was 31% (53.2% and 12.5% for men and women, respectively). 14% were former smokers (20.9% of men and 9.5% of women) while 25.9% of men and 78.1% of women were never smokers.Among current male smokers, the highest prevalence (57.7%) belonged to the 20-29 age group. While among current female smokers, the highest prevalence (23.2%) belonged to the greater than 70-year-old category.There were more current smokers in the rural areas (33.1%) than the urban areas (28.9%) and there were more current and former smokers among respondents whose educational attainment was at least tertiary level (62.7%). CONCLUSION: Tobacco use in the Philippines is still prevalent at 31% and is predominantly composed of males in the 20-29 age group. Current smoking is highest among rural dwellers and among individuals with elementary education, while majority of women and college level respondents are never smokers.