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Am J Cardiol. 2014 Mar 1;113(5):793-7. doi: 10.1016/j.amjcard.2013.11.024. Epub 2013 Dec 12.

Utilization of evidence-based therapy for acute coronary syndrome in high-income and low/middle-income countries.

Author information

1
Divisions of Cardiology and Clinical Epidemiology, Jewish General Hospital, Lady Davis Institute for Medical Research, McGill University, Montreal, Quebec, Canada.
2
Divisions of Cardiology and Clinical Epidemiology, Jewish General Hospital, Lady Davis Institute for Medical Research, McGill University, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.
3
Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada; Division of Clinical Epidemiology, McGill University Health Centre, Montreal, Quebec, Canada; Division of General Internal Medicine, McGill University Health Centre, Montreal, Quebec, Canada.
4
Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada; Division of Clinical Epidemiology, McGill University Health Centre, Montreal, Quebec, Canada.
5
Department of Social and Preventive Medicine, Université de Montréal, Montreal, Quebec, Canada.
6
Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.
7
Multidisciplinary Cardiology Department, Quebec Heart-Lung Institute, Quebec City, Quebec, Canada.
8
Isfahan Cardiovascular Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
9
Interactive Research and Development Center, Karachi, Pakistan.
10
Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.
11
Cardiac Thrombosis Research Unit, Department of Cardiology A, Fattouma Bourguiba University Hospital, Monastir, Tunisia.
12
Division of Cardiology, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada.
13
Divisions of Cardiology and Clinical Epidemiology, Jewish General Hospital, Lady Davis Institute for Medical Research, McGill University, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada. Electronic address: mark.eisenberg@mcgill.ca.

Abstract

Limited data exist regarding the management of patients with acute coronary syndrome (ACS) in high-income countries compared with low/middle-income countries. We aimed to compare in-hospital trends of revascularization and prescription of medications at discharge in patients with ACS from high-income (Canada and United States) and low/middle-income (India, Iran, Pakistan, and Tunisia) countries. Data from a double-blind, placebo-controlled, randomized trial investigating the effect of bupropion on smoking cessation in patients after an enzyme-positive ACS was used for our study. A total of 392 patients, 265 and 127 from high-income and from low/middle-income countries, respectively, were enrolled. Patients from high-income countries were older, and were more likely to have diagnosed hypertension and dyslipidemia. During the index hospitalization, patients from high-income countries were more likely to be treated by percutaneous coronary intervention (odds ratio [OR] 19.7, 95% confidence interval [CI] 10.5 to 37.0). Patients with ST elevation myocardial infarction from high-income countries were more often treated by primary percutaneous coronary intervention (OR 16.3, 95% CI 6.3 to 42.3) in contrast with thrombolytic therapy (OR 0.24, 95% CI 0.14 to 0.41). Patients from high-income countries were also more likely to receive evidence-based medications at discharge (OR 2.32, 95% CI 1.19 to 4.52, a composite of aspirin, clopidogrel, and statin). In conclusion, patients with ACS in low/middle-income countries were less likely to be revascularized and to receive evidence-based medications at discharge. Further studies are needed to understand the underutilization of procedures and evidence-based medications in low/middle-income countries.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT00689611.

PMID:
24440324
DOI:
10.1016/j.amjcard.2013.11.024
[Indexed for MEDLINE]

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