A descriptive study on the initial management of patients with acute coronary syndrome in emergency rooms of Philippine hospitals

ABSTRACT

BACKGROUND: Morbidity and mortality from acute coronary syndrome (ACS) primarily depends on prompt evaluation and management of patients. Despite available recommendations on ACS management, there is limited data regarding Filipino physician's knowledge and adherence with these guidelines in the emergency room (ER).OBJECTIVES: To describe the initial management of ACS patients by Filipino physicians at the ER and to document their adherence with the 2007 American College of Cardiology/American Heart Association (ACC/AHA) ACS guidelines for the management of patients with unstable angina (UA)/ non-ST-segment elevation myocardial infraction (NSTEMI) and ST-segment elevation myocardial infraction (STEMI).METHODS: This was an open-label, descriptive, multicenter, non-interventional study that enrolled patients ? 18 years of age, seen at the ER and suspected to have UA or MI with or without ST-segment elevation. Patient demographics, medical history, physical and laboratory examinations, medications or interventions done at the ER and the specialty of physicians who provided the initial management were recorded. Adherence with the 2007 ACC/AHAACS guidelines was also assessed. Data were summarized using descriptive statistics.RESULTS: A total of 1,398 eligible patients (mean age 61.58+ 12.03 years) were included in the study. At least one cardiac enzyme test was requested in up to 93% of patients, with troponin I being the most common (72.53%). Upon diagnosis, 95.78% of patients were given antiplatelet therapy (16.95% clopidogrel alone, 15.31% aspirin alone and 1.07% other antiplatelet drugs), the combination therapy. Moreover, 86.27% were given anticoagulant therapy (75.75% enoxaparin, 5.94% fondaprinux and 3.97% IV UFH). Ninety-eight percent of patients we subsequently admitted in the hospital and 26.68% of patients were considered to undergo percutaneous coronary intervention (PCI). Majority of these patients were initially managed by ER physicians (52.22%).CONCLUSION: Filipino physicians at the ER provide an appropriate management strategy to individual ACS patients because their management adheres to the 2007 and the current ACC/AHA ACS guidelines. The outcome and impact of these strategies should be assessed to encourage more physicians to conform with available recommendations. Moreover, a review of adherence of physicians to other disease management guidelines should be conducted to further improve care and outcomes in ER.