exudates and Acute-Coronary-Syndrome

Medication non-adherence leads to a vast range of negative outcomes in patients with coronary artery disease. An automated web-based system managing short message service (SMS) reminders is a telemedicine approach to optimise adherence among patients who frequently forget to take their medications or miss the timing.. This paper sought to investigate the effect of automated SMS-based reminders on medication adherence in patients after hospital discharge following acute coronary syndrome (ACS).. An interventional study was conducted at a tertiary teaching hospital in Malaysia. A total of 62 patients with ACS were equally randomised to receive either automated SMS reminders before every intake of cardiac medications or only usual care within eight weeks after discharge. The primary outcome was adherence to cardiac medications. Secondary outcomes were the heart functional status, and ACS-related hospital readmission and death rates.. There was a higher medication adherence level in the intervention group rather than the usual care group, (χ(2) (2)=18.614, p<0.001). The risk of being low adherent among the control group was 4.09 times greater than the intervention group (relative risk =4.09, 95% confidence interval (CI) 1.82-9.18). A meaningful difference was found in heart functional status between the two study groups with better results among patients who received SMS reminders, (χ(2) (1) = 16.957, p<0.001).. An automated SMS-based reminder system can potentially enhance medication adherence in ACS patients during the early post-discharge period.

Topics: Acute Coronary Syndrome; Aged; Cardiovascular Agents; Female; Humans; Malaysia; Male; Medication Adherence; Middle Aged; Patient Discharge; Patient Preference; Patient Readmission; Reminder Systems; Self Report; Text Messaging

Despite extensive advances in medical and surgical treatment, cardiovascular disease (CVD) remains the leading cause of mortality worldwide. Identifying the significant predictors will help clinicians with the prognosis of the disease and patient management. This study aims to identify and interpret the dependence structure between the predictors and health outcomes of ST-elevation myocardial infarction (STEMI) male patients in Malaysian setting.. Retrospective study.. Malaysian National Cardiovascular Disease Database-Acute Coronary Syndrome (NCVD-ACS) registry years 2006-2013, which consists of 18 hospitals across the country.. 7180 male patients diagnosed with STEMI from the NCVD-ACS registry.. A graphical model based on the Bayesian network (BN) approach has been considered. A bootstrap resampling approach was integrated into the structural learning algorithm to estimate probabilistic relations between the studied features that have the strongest influence and support.. The relationships between 16 features in the domain of CVD were visualised. From the bootstrap resampling approach, out of 250, only 25 arcs are significant (strength value ≥0.85 and the direction value ≥0.50). Age group, Killip class and renal disease were classified as the key predictors in the BN model for male patients as they were the most influential variables directly connected to the outcome, which is the patient status. Widespread probabilistic associations between the key predictors and the remaining variables were observed in the network structure. High likelihood values are observed for patient status variable stated alive (93.8%), Killip class I on presentation (66.8%), patient younger than 65 (81.1%), smoker patient (77.2%) and ethnic Malay (59.2%). The BN model has been shown to have good predictive performance.. The data visualisation analysis can be a powerful tool to understand the relationships between the CVD prognostic variables and can be useful to clinicians.

Topics: Acute Coronary Syndrome; Bayes Theorem; Cardiovascular Diseases; Humans; Malaysia; Male; Percutaneous Coronary Intervention; Registries; Retrospective Studies; Risk Factors; ST Elevation Myocardial Infarction

The importance of networking for the management of acute coronary syndrome (ACS) has been emphasised in the 2012 guidelines by the European Society of Cardiology (ESC) on ST-segment elevation myocardial infarction (STEMI). In Penang, the ACS referral network has the Penang General Hospital (PGH), a percutaneous coronary intervention (PCI)- capable hospital, with 14 other hospitals referring their patients for PCI to PGH on a daily basis. In one of its review regarding the referral methodology in the network, PGH's Cardiology centre observed gaps in the referral systems, which was leading to poor quality of referrals. To address these issues, the PGH Cardiology centre developed a standardised protocol and conducted a one-day workshop to educate medical officers about the standardised protocol. This commentary piece is a proof of this concept, and aims to share the experience and provide an overview on the initiatives by the PGH, which has resulted in improved quality of PCI referrals.

Topics: Acute Coronary Syndrome; Cardiology Service, Hospital; Clinical Protocols; Health Services Accessibility; Hospitals, General; Humans; Malaysia; Percutaneous Coronary Intervention; Quality Improvement; Referral and Consultation

Coronary heart disease has emerged as a number one killer in Malaysia and globally. Much of the morbidity and mortality in acute coronary syndrome patients is because of patients not recognizing their symptoms which contributes to delay in seeking early treatment.. The aim of this study is to evaluate the effectiveness of a nurse-led health education programme on knowledge, attitude and beliefs of coronary patients towards the responses to acute coronary syndrome and the association with patients' characteristics.. A single-group quasi-experimental design took place in a tertiary hospital. A total of 60 coronary patients were recruited to this study. The knowledge, attitude and beliefs towards acute coronary syndrome (ACS) were evaluated at baseline and after 1 month of giving education intervention.. Knowledge, attitude and beliefs about ACS increased significantly from baseline to 1 month after intervention. Level of attitude was associated with gender, educational level and employment status.. The findings of this study suggest that an education program conducted by a nurse improved patients' level of knowledge, attitudes and beliefs in response to ACS symptoms at 1 month compared to baseline, but whether they are sustained for a longer period is unclear. Improving the responses towards ACS might reduce decision delay in symptom interpretation and seeking early treatment.. Nurse-led interventions have imparted positive outcomes in response to ACS symptoms among coronary patients. Therefore, nurses should take the initiative in educating patients to minimize delay in symptom interpretation and seeking early treatment.

Topics: Acute Coronary Syndrome; Critical Care Nursing; Female; Health Knowledge, Attitudes, Practice; Humans; Malaysia; Male; Middle Aged; Patient Education as Topic

Malaysia and Sweden have mapped their acute coronary syndrome registries using SNOMED CT. Since similar-purposed patient registries can be expected to collect similar data, these data should be mapped to the same SNOMED CT codes despite the different languages used. Previous studies have however shown variations in mapping between different mappers but the reasons behind these variations and the influence of different mapping approaches are still unknown.. To analyze similar-purposed registries and their registry-to-SNOMED CT maps, using two national acute coronary syndrome registries as examples, to understand the reasons for mapping similarities and differences as well as their implications.. The Malaysian National Cardiovascular Disease - Acute Coronary Syndrome (NCVD-ACS) registry was compared to the Swedish Register of Information and Knowledge about Swedish Heart Intensive Care Admissions (RIKS-HIA). The structures of NCVD-ACS and RIKS-HIA registry forms and their distributions of headings, variables and values were studied. Data items with equivalent meaning (EDIs) were paired and their mappings were categorized into match, mismatch, and non-comparable mappings. Reasons for match, mismatch and non-comparability of each paired EDI were seen as factors that contributed to the similarities and differences between the maps.. The registries and their respective maps share a similar distribution pattern regarding the number of headings, variables and values. The registries shared 101 EDIs, whereof 42 % (42) were mapped to SNOMED CT. 45 % (19) of those SNOMED CT coded EDIs had matching codes. The matching EDIs occurred only in pre-coordinated SNOMED CT expressions. Mismatches occurred due to challenges arising from the mappers themselves, limitations in SNOMED CT, and complexity of the registries. Non-comparable mappings appeared due to the use of other coding systems, unmapped data items, as well as requests for new SNOMED CT concepts.. To ensure reproducible and reusable maps, the following three actions are recommended: (i) develop a specific mapping guideline for patient registries; (ii) openly share maps; and (iii) establish collaboration between clinical research societies and the SNOMED CT community.

Topics: Acute Coronary Syndrome; Humans; Malaysia; Registries; Statistics as Topic; Sweden; Systematized Nomenclature of Medicine

Acute Coronary Syndrome (ACS) is one of the most burdensome cardiovascular diseases in terms of the cost of interventions. The Cardiac Rehabilitation Programme (CRP) is well-established in improving clinical outcomes but the assessment of actual clinical improvement is challenging, especially when considering pharmaceutical care (PC) values in phase I CRP during admission and upon discharge from hospital and phase II outpatient interventions. This study explores the impact of pharmacists' interventions in the early stages of CRP on humanistic outcomes and follow-up at a referral hospital in Malaysia.. We recruited 112 patients who were newly diagnosed with ACS and treated at the referral hospital, Sarawak General Hospital, Malaysia. In the intervention group (modified CRP), all medication was reviewed by the clinical pharmacists, focusing on drug indication; understanding of secondary prevention therapy and adherence to treatment strategy. We compared the "pre-post" quality of life (QoL) of three groups (intervention, conventional and control) at baseline, 6 months and 12 months post-discharge with Malaysian norms. QoL data was obtained using a validated version of Short-Form 36 Questionnaire (SF-36). Analysis of variance (ANOVA) with repeated measure tests was used to compare the mean differences of scores over time.. A pre-post quasi-experimental non-equivalent group comparison design was applied to 112 patients who were followed up for one year. At baseline, the physical and mental health summaries reported poor outcomes in all three groups. However, these improved gradually but significantly over time. After the 6-month follow-up, the physical component summary reported in the modified CRP (MCRP) participants was higher, with a mean difference of 8.02 (p = 0.015) but worse in the mental component summary, with a mean difference of -4.13. At the 12-month follow-up, the MCRP participants performed better in their physical component (PCS) than those in the CCRP and control groups, with a mean difference of 11.46 (p = 0.008), 10.96 (p = 0.002) and 6.41 (p = 0.006) respectively. Comparing the changes over time for minimal important differences (MICD), the MCRP group showed better social functioning than the CCRP and control groups with mean differences of 20.53 (p = 0.03), 14.47 and 8.8, respectively. In role emotional subscales all three groups showed significant improvement in MCID with mean differences of 30.96 (p = 0.048), 31.58 (p = 0.022) and 37.04 (p < 0.001) respectively.. Our results showed that pharmaceutical care intervention significantly improved HRQoL. The study also highlights the importance of early rehabilitation in the hospital setting. The MCRP group consistently showed better QoL, was more highly motivated and benefitted most from the CRP.. Medical Research and Ethics Committee (MREC) Ministry of Health Malaysia, November 2007, NMRR-08-246-1401.

Topics: Acute Coronary Syndrome; Cardiac Rehabilitation; Female; Hospitalization; Humans; Malaysia; Male; Middle Aged; Outcome Assessment, Health Care; Patient Discharge; Quality of Life; Surveys and Questionnaires

The elderly are often underrepresented in clinical trials for acute coronary syndrome (ACS), and cardiologists commonly face management dilemmas in the choice of treatment for this group of patients, particularly concerning the use of invasive revascularisation. This study analysed the characteristics of hospitalised elderly patients with ACS, and compared the outcomes of treatments.. From 29 December 2005 to 26 April 2010, 13,545 patients were admitted for ACS in 16 hospitals across Malaysia. These patients were divided into two groups - elderly (≥ 65 years) and non-elderly (< 65 years). The clinical characteristics, treatment received (invasive or non-invasive) and outcomes (in-hospital and 30-day all-cause mortality) of the two groups were compared. The elderly patients were then grouped according to the type of treatment received, and the outcomes of the two subgroups were compared.. Elderly patients had a higher cardiovascular risk burden and a higher incidence of comorbidities. They were less likely to receive urgent revascularisation for acute ST-segment elevation myocardial infarction (elderly: 73.9% vs. non-elderly: 81.4%) and had longer door-to-needle time (elderly: 60 minutes vs. non-elderly: 50 minutes, p = 0.004). The rate of cardiac catheterisation was significantly lower in the elderly group across all ACS strata. Elderly patients had poorer outcomes than non-elderly patients, but those who received invasive treatment appeared to have better outcomes than those who received non-invasive treatment.. Elderly patients with ACS tend to be undertreated, both invasively and pharmacologically. Invasive treatment seems to yield better outcomes for this group of patients.

Topics: Acute Coronary Syndrome; Age Factors; Aged; Cardiovascular Diseases; Databases, Factual; Female; Humans; Malaysia; Male; Middle Aged; Morbidity; Registries; Survival Rate

Non-alcoholic fatty liver disease (NAFLD) and cardiovascular diseases are both common among patients with diabetes mellitus.. The aim of this study is to determine if ultrasonography-diagnosed NAFLD is associated with prevalent ischemic heart disease (IHD) among patients with diabetes mellitus.. This is a cross-sectional study on consecutive patients seen at the Diabetic Clinic, University of Malaya Medical Centre. The medical record for each patient was reviewed for documented IHD. Patients without documented IHD but had symptoms and/or electrocardiographic changes suggestive of IHD were referred for cardiac evaluation.. Data for 399 patients were analyzed. Mean age was 62.8±10.5 years with 43.1% male. NAFLD and IHD were present in 49.6 and 26.6%, respectively. The prevalence of IHD among patients with and without NAFLD was 24.7 and 28.4%, respectively (P=0.414). The prevalence of IHD was highest among the Indians (34.1%) followed by the Malays (29.2%) and the Chinese (20.1%). No association was found between NAFLD and IHD when analyzed according to ethnicity. On multivariate analysis, independent factors associated with IHD were older age, lower levels of physical activity, greater waist circumference and higher serum glycated hemoglobin level.. Ultrasonography-diagnosed NAFLD was not associated with prevalent IHD among patients with diabetes mellitus in a multiracial Asian hospital clinic population.

Topics: Acute Coronary Syndrome; Age Factors; Coronary Artery Disease; Cross-Sectional Studies; Diabetes Mellitus; Female; Glycated Hemoglobin; Humans; Malaysia; Male; Middle Aged; Multivariate Analysis; Non-alcoholic Fatty Liver Disease; Outpatient Clinics, Hospital; Racial Groups; Sedentary Behavior; Ultrasonography; Waist Circumference

Sex differences in acute coronary syndrome (ACS) have been well studied in major registries and clinical trials in Western populations. Limited studies have examined the sex differences in ACS using a large number of Asian women as the subjects.. The aim was to study the sex differences in ACS using the NCVD-ACS (National Cardiovascular Disease Database-Acute Coronary Syndrome) registry.. We analyzed 13,591 ACS patients, of which 75.8% were men and 24.2% were women, from March 2006 to February 2010. Data were collected on demographic characteristics, risk factors, anthropometrics, treatments, procedures, mortalities, and complications. The results were compared among 3 cohorts of ACS (ST-segment elevation myocardial infarction [STEMI], non-STEMI, and unstable angina).. Women were older and more likely to have diabetes, hypertension, previous heart failure, and cerebral vascular accidents than men were. Women were less likely to receive in-hospital administration of aspirin, beta-blockers, angiotensin-converting enzyme inhibitors, or angiotensin receptor blockers, and they were less likely to undergo angiography and percutaneous coronary intervention. In STEMI, a significantly lower proportion of women than men received primary percutaneous coronary intervention (6.2% vs. 6.7%, respectively, p = 0.000) and fibrinolysis (64.4% vs. 74.6%, respectively, p = 0.000). In addition, with regard to STEMI, women had a significantly higher unadjusted in-hospital mortality rate than men did (15.0% vs. 8.1%, respectively, p < 0.000). There was no statistically significant in-hospital mortality difference between sexes for non-STEMI and unstable angina. After adjustment for age and other covariates, a multivariate analysis showed no sex differences in the in-hospital mortality in all spectrums of ACS.. Our study showed significant sex differences in the demographic characteristics, risk factors, treatments, and outcomes of ACS. More importantly, in ACS patients, we found evidence of suboptimal treatments and interventions in women versus men. Our findings provide an opportunity to narrow the sex gap in the care of women with ACS in Malaysia.

Topics: Acute Coronary Syndrome; Adult; Aged; Asian People; Databases, Factual; Ethnicity; Female; Humans; Malaysia; Male; Middle Aged; Registries; Sex Factors

The National Cardiovascular Disease (NCVD) Database Registry represents one of the first prospective, multi-center registries to treat and prevent coronary artery disease (CAD) in Malaysia. Since ethnicity is an important consideration in the occurrence of acute coronary syndrome (ACS) globally, therefore, we aimed to identify the role of ethnicity in the occurrence of ACS among high-risk groups in the Malaysian population.. The NCVD involves more than 15 Ministry of Health (MOH) hospitals nationwide, universities and the National Heart Institute and enrolls patients presenting with ACS [ST-elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction (NSTEMI) and unstable angina (UA)]. We analyzed ethnic differences across socio-demographic characteristics, hospital medications and invasive therapeutic procedures, treatment of STEMI and in-hospital clinical outcomes.. We enrolled 13,591 patients. The distribution of the NCVD population was as follows: 49.0% Malays, 22.5% Chinese, 23.1% Indians and 5.3% Others (representing other indigenous groups and non-Malaysian nationals). The mean age (SD) of ACS patients at presentation was 59.1 (12.0) years. More than 70% were males. A higher proportion of patients within each ethnic group had more than two coronary risk factors. Malays had higher body mass index (BMI). Chinese had highest rate of hypertension and hyperlipidemia. Indians had higher rate of diabetes mellitus (DM) and family history of premature CAD. Overall, more patients had STEMI than NSTEMI or UA among all ethnic groups. The use of aspirin was more than 94% among all ethnic groups. Utilization rates for elective and emergency percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) were low among all ethnic groups. In STEMI, fibrinolysis (streptokinase) appeared to be the dominant treatment options (>70%) for all ethnic groups. In-hospital mortality rates for STEMI across ethnicity ranges from 8.1% to 10.1% (p = 0.35). Among NSTEMI/UA patients, the rate of in-hospital mortality ranges from 3.7% to 6.5% and Malays recorded the highest in-hospital mortality rate compared to other ethnic groups (p = 0.000). In binary multiple logistic regression analysis, differences across ethnicity in the age and sex-adjusted ORs for in-hospital mortality among STEMI patients was not significant; for NSTEMI/UA patients, Chinese [OR 0.71 (95% CI 0.55, 0.91)] and Indians [OR 0.57 (95% CI 0.43, 0.76)] showed significantly lower risk of in-hospital mortality compared to Malays (reference group).. Risk factor profiles and ACS stratum were significantly different across ethnicity. Despite disparities in risk factors, clinical presentation, medical treatment and invasive management, ethnic differences in the risk of in-hospital mortality was not significant among STEMI patients. However, Chinese and Indians showed significantly lower risk of in-hospital mortality compared to Malays among NSTEMI and UA patients.

Topics: Acute Coronary Syndrome; Adult; Aged; Asian People; Databases, Factual; Female; Hospitalization; Humans; India; Malaysia; Male; Middle Aged; Prospective Studies; Registries; Risk Factors; White People

Despite the availability of various prevention guidelines on acute coronary syndrome (ACS), secondary prevention practice utilizing aspirin, beta-blockers, angiotensin converting enzyme inhibitors and statins still can be sub-optimal.. To review and document the utilization of pharmacotherapy for the secondary prevention of ACS in patients discharged from a Malaysian hospital.. A retrospective cross-sectional study was conducted at a tertiary hospital in Penang, Malaysia. Patients with a primary diagnosis of ACS were identified from medical records over a 4-month period. A range of clinical data was extracted from medical records, including medical history, clinical presentation and pharmacotherapy both on admission and at discharge. This audit focused on the use of four guideline-recommended therapies: aspirin ± clopidogrel, beta-blockers, statins and angiotensin-converting enzyme inhibitor (ACEI)/angiotensin II receptor blockers (ARBs).. Data pertaining to a total of 380 ACS patients was extracted and reviewed, the mean age of the study population was 57.49 years and 73.9% of population was males. Patients with unstable angina accounted for 56.6% of the admissions whereas 23.4% and 20% of the patients were admitted for ST-elevation myocardial infarction and non-ST-segment elevation infarct respectively. 95.7% of the patients received antiplatelets comprising of at least aspirin, and 82% received aspirin plus clopidogrel. Furthermore, 80.3% of the patients received a beta-blocker at discharge, 95% a statin and 69.7% received either an ACEI or ARB. Compared with patients who presented with myocardial infarction (with or without ST-segment elevation), those presenting with unstable angina were less likely to receive the combination of aspirin plus clopidogrel or an ACEI/ARB at discharge. Patients over 65 years of age were also less likely to receive a beta-blocker at discharge, compared with younger patients.. There is a good adherence to evidence-based guidelines for the secondary prevention of ACS in this local setting. However, there is some potential underutilization in the older population and patients presenting with unstable angina.

Topics: Acute Coronary Syndrome; Adult; Aged; Aged, 80 and over; Cardiovascular Agents; Cross-Sectional Studies; Drug Utilization; Evidence-Based Practice; Female; Guideline Adherence; Humans; Malaysia; Male; Middle Aged; Practice Guidelines as Topic; Retrospective Studies; Secondary Prevention; Tertiary Care Centers

Poor adherence is a significant nursing and public health concern because it affects patients' quality of life. It compounds the disease burden of the growing coronary heart disease population. Promoting optimal patient adherence to cardiac-health enhancing recommendations by healthcare providers can reduce mortality and morbidity risk after acute coronary syndrome (ACS).. This paper sought to examine rates and predictors of patient adherence to health recommendations after ACS.. A cross-sectional survey of 210 Malaysian patients using consecutive sampling was conducted in early 2009 at a tertiary teaching hospital. The Medical Outcome Study Specific Adherence Scale (MOSSAS) questionnaire was adapted to measure the extent of patient adherence to recalled health recommendations. Logistic regression modelling was applied to determine odds ratio and factors of suboptimal adherence.. The suboptimal adherence rate was 65.2% (95% CI 58.8-71.7%). Recall of recommendation rates varied from 38.1% to 95.3%, whereas the adherence rates varied from 22.1% to 95.1% across the six aspects of health recommendation namely medication taking, dietary modification, regular physical exercise, stress reduction, gathering social support and avoidance of substance abuse. Those who had to adhere to more than three aspects of recommendations, active smokers and the Malay ethnic race had higher odds of suboptimal adherence.. Monitoring of patient recall and adherence rate may provide information on the effectiveness of patient care management and outcomes. Identifying patients with higher risk for poor adherence is recommended for more targeted interventions.

Topics: Acute Coronary Syndrome; Adult; Aged; Cross-Sectional Studies; Female; Health Behavior; Humans; Malaysia; Male; Medication Adherence; Middle Aged; Odds Ratio; Patient Compliance; Regression Analysis; Reproducibility of Results; Surveys and Questionnaires

Secondary prevention pharmacotherapy improves outcomes after acute coronary syndrome (ACS). However, poor medication adherence is common, and various factors play a role in adherence.. The purpose of this study was to evaluate patients' level of adherence to evidence-based therapies at an average of 6 months after discharge for acs and to identify factors associated with self-reported non-adherence.. This prospective study was conducted in the outpatient cardiac clinics of Hospital Pulau Pinang, located in Penang Island, a northern state in Malaysia.. A random sample of ACS patients (n = 190) who had been discharged on a regimen of secondary preventive medications were included in this study. Six months after discharge and during their scheduled follow-up appointments to cardiac clinics, patients were interviewed using the translated eight-item Morisky Medication Adherence Scale.. self-reported patients' adherence to medication.. Six months following their hospital discharge, only 35 patients (18.4 %) reported high adherence. Medium adherence was reported in majority of patients (51.1 %). Low adherence was reported in 58 patients (30.5 %). Forgetfulness was the most frequently reported reason for patients' non-adherence to their medications (23.2 %). Furthermore, this study identified 5 factors-namely age, employment status, ACS subtypes, number of comorbidities, and number of prescription medications per day-that may influence Patients' level of adherence to the prescribed regimens.. Our findings revealed a problem of non-adherence to secondary prevention medications among patients with ACS in Malaysia. Furthermore, this study demonstrates that older patients, unemployed patients, patients with more comorbid conditions, and those receiving multiple medications are less likely to adhere to their prescribed medications 6 months after hospital discharge.

Topics: Acute Coronary Syndrome; Adult; Age Factors; Aged; Aged, 80 and over; Comorbidity; Employment; Evidence-Based Medicine; Female; Follow-Up Studies; Humans; Malaysia; Male; Medication Adherence; Middle Aged; Prospective Studies; Secondary Prevention

The aim of this study is to determine risks factor of mortality among patient with post percutaneous coronary intervention. Estimation of post operative mortality risk factor is essential for planning prevention modalities. This is retrospective cohort study based on secondary data extracted from the National Cardiovascular Disease Database (NCVD-ACS and NCVD PCI). Both these registries were interlinked and was further matched to JPN (Jabatan Pendaftaran Negara/National registration Department) to assess mortality among the patients who underwent PCI and all death which occurred in between 2007, 2008 and 2009. There were 630 patients in this studied. Age, history of diabetes mellitus, peripheral vascular, renal failure and previous percutaneous coronary intervention were univariately associated with mortality. However based on logistics stepwise method, only age and history of renal failure had showed statistically significant and sizeable odds ratio in predicting the patient died of coronary death. Older age and renal failure are the predicting factors for mortality among patients with post percutaneous coronary intervention.

Topics: Acute Coronary Syndrome; Cardiovascular Diseases; Cohort Studies; Humans; Malaysia; Percutaneous Coronary Intervention; Registries; Retrospective Studies

The ACute CORonary syndromes Descriptive study (ACCORD) is a prospective observational study that evaluates the management of acute coronary syndrome (ACS) in clinical practice and the use of antiplatelet agents in acute settings and after discharge. The secondary objective of this study was to obtain information on risk factors in a large cohort of patients with ACS.. The study population included subjects aged at least 21 years who had unstable angina or non-ST elevation myocardial infarction. The patients had four follow-up visits over a one-year period.. A total of 525 patients from Malaysia were enrolled into the study. The mean age of the patients was 58.14 +/- 11.3 years, and the mean body mass index was 25.4 +/- 4.3 kg/m2. 96.8 percent of subjects had at least one cardiovascular risk factor. Following hospitalisation, 83.6 percent of patients were managed medically. During the follow-up visits, 62.7-77.6 percent of patients received aspirin only, 5.0-6.8 percent received clopidogrel only and 15.6-32.3 percent received dual antiplatelet medications. Compliance with aspirin was 93.5-96.5 percent. Clopidogrel compliance was above 80 percent of the prescribed tablets for more than 88 percent of patients.. Patients in the Malaysia-ACCORD registry were much younger compared to those in the Global Registry of Acute Coronary Events. The majority of patients had cardiovascular risk factors at presentation and were treated medically, and those on dual antiplatelet therapy had a relatively high level of compliance.

Topics: Acute Coronary Syndrome; Adult; Aspirin; Clopidogrel; Drug Therapy, Combination; Female; Guideline Adherence; Humans; Malaysia; Male; Medication Adherence; Middle Aged; Platelet Aggregation Inhibitors; Practice Patterns, Physicians'; Prospective Studies; Risk Factors; Ticlopidine

Early identification and rapid treatment of red tag patients may decrease morbidity and mortality. We examined the clinical characteristics, etiologies and one week mortality rate of red tag (life threatening and potentially life threatening illness) patients at the Hospital Universiti Sains Malaysai (HUSM). A cross-sectional study was conducted at the Emergency Department of the HUSM from 1 August 2006 to 31 January 2007; 440 eligible patients were analyzed. The group had a mean age of 47.2 +/- 22 years, with 67.3% of the patients being male. Twenty-three percent were trauma cases with motor vehicle accident being the major mechanism of injury. Fifty-four percent of the cases had cardiac related illnesses. The mean duration of stay in the Emergency Department (ED) was 3.9 +/- 1.5 hours. The survival rate at one week was 76.6%. The non-trauma group comprised 74.0% of death cases. Acute coronary syndrome and road traffic accidents comprised 22.0% of total death cases at one week. Red tag patients constitute a large proportion of ED cases and may remain in the ED for significant periods of time.

Topics: Accidents, Traffic; Acute Coronary Syndrome; Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Critical Illness; Cross-Sectional Studies; Female; Hospital Mortality; Hospitals, University; Humans; Infant; Length of Stay; Malaysia; Male; Middle Aged; Survival Rate; Triage; Wounds and Injuries

Coronary artery disease is one of the most rampant non-communicable diseases in the world. It begins indolently as a fatty streak in the lining of the artery that soon progresses to narrow the coronary arteries and impair myocardial perfusion. Often the atherosclerotic plaque ruptures and causes sudden thrombotic occlusion and acute ST-elevation myocardial infarction (STEMI), non-ST-elevation MI (NSTEMI) or unstable angina (UA). This phenomenon is called acute coronary syndrome (ACS) and is the leading cause of death not only in Malaysia but also globally. In order for us to tackle this threat to the health of our nation we must arm ourselves with reliable and accurate information to assess current burden of disease resources available and success of current strategies. The acute coronary syndrome (ACS) registry is the flagship of the National Cardiovascular Disease Database (NCVD) and is the result of the dedicated and untiring efforts of doctors and nurses in both public and private medical institutions and hospitals around the country, ably guided and supported by the National Heart Association, the National Heart Foundation, the Clinical Research Centre and the Ministry of Health of Malaysia. Analyses of data collected throughout 2006 from 3422 patients with ACS admitted to the 12 tertiary cardiac centres and general hospitals spanning nine states in Malaysia in this first report has already revealed surprising results. Mean age of patients was 59 years while the most consistent risk factor for STEMI was active smoking. Utilization of medications was high generally. Thirty-day mortality for STEMI was 11%, for NSTEMI 8% and UA 4%. Thrombolysis (for STEMI only) reduced in-hospital and 30-day mortality by nearly 50%. Percutaneous coronary intervention or PCI also reduced 30-day mortality for patients with non-ST elevation MI and unstable angina. The strongest determinants of mortality appears to be Killip Class and age of the patient. Fewer women received thrombolysis or underwent PCI on same admission although women make up 25% of the cohort.

Topics: Acute Coronary Syndrome; Aged; Aged, 80 and over; Databases, Factual; Disease Progression; Female; Fibrinolytic Agents; Humans; Malaysia; Male; Middle Aged; Myocardial Infarction; Myocardial Reperfusion; Population Surveillance; Registries; Risk Factors