The prolonged length of stay for patients in our center, which were not provided with surgical intervention, cardiac rehabilitation or behavioral treatment, may be due to the lack of resources and inability to obtain essential investigations such as echocardiography; waiting for an inpatient bed; or delayed discharge due to patients awaiting medication or relatives to take them home

The prolonged length of stay for patients in our center, which were not provided with surgical intervention, cardiac rehabilitation or behavioral treatment, may be due to the lack of resources and inability to obtain essential investigations such as echocardiography; waiting for an inpatient bed; or delayed discharge due to patients awaiting medication or relatives to take them home. patients with ST elevation MI), but none of the patients had primary angioplasty. Thrombolysis was higher among younger patients and in men. There were no differences in age, sex, and ethnicity in all other treatments. Of the 360 patients with recorded occasions, 41.1% arrived at the hospital within 4?h. The proportion of patients receiving thrombolysis (door to needle time) within 30?min was 57.5%. In-patient treatment medication included: aspirin (87.1%), clopidogrel (87.2%), beta blockers (76.5%), ACEI (72.9%), heparin (80.6%), and simvastatin (82.5%). Documentation of risk stratification, use of angiogram and surgical intervention, initiation of cardiac rehabilitation (CR), and information on behavioral changes were rare. Electrocardiogram (ECG) and cardiac enzyme assessments were universally performed, while echocardiogram was performed in 57.1% of patients and exercise pressure test was performed occasionally. Discharge treatment was limited to medication and referrals for investigations. Few patients were given lifestyle and activity guidance and referred for CR. The in-hospital death rate was 6.5%. There was a significantly higher relative risk of in-hospital death for non-use of aspirin, clopidogrel, simvastatin, beta blockers, and heparin, but not ACE inhibitors and nitrates. Conclusions Medication usage was high among AMI patients. However, there was very minimal use of non-pharmacological steps. No differences were found in prescribed medication by age, sex, or ethnicity, with the exception of thrombolysis. angiotensin-converting enzyme, angiotensin II receptor blocker, electrocardiogram, exercise stress test, Global Registry of Acute Coronary Events, heart rate, non-ST-elevation myocardial infarction, percutaneous coronary intervention, ST-elevation myocardial infarction, Thrombolysis in Myocardial Infarction, Treatment not available or missing data Open in a separate windows Fig. 2 Frequency of discharge treatment recommendation. (Legend) ACEi, angiotensin converting enzyme inhibitor; BP, blood pressure; DM, diabetes mellitus; MI, myocardial infarction Outcomes The average length of stay was 6.71??5.77?days (range, 1C61?days). The majority of patients stayed between 3 and 8?days ( em n /em Isoacteoside ?=?756, 70.9%) while a minority stayed ?3 or? ?8?days ( em n /em ?=?311, 29.1%). Less than 2 % of the patients suffered at least one of the following complications: hypotension, arrhythmia, and bradyarrythmia requiring temporary pacing, recurrent ischemia or infarction, left ventricle failure, pericarditis, bleeding requiring transfusion, contamination, and new neurologic event. Of the 1106 patients in the sample, 72 in-hospital deaths were recorded, which equates to an in-hospital death rate of 65 per thousand (46 male and 26 female, which is equivalent to an in-hospital death rate of 6.18 and 7.2% for males and females, respectively). Discussion In this resource limiting country, AMI treatment largely focused on pharmacological treatment. EBG emergency treatment comprising of aspirin (97.2%), clopidogrel (97.2%), and heparin (81.3%) was relatively high. Thrombolytic treatment was received by the majority (70.5%) of patients. The use of thrombolysis was significantly higher in men than in women; and in younger compared to older patients. The proportion of patients thrombolysed ( em n /em ?=?356/505, 70.5%) compares well or is even better than in other developing countries. In Sri Lanka, 70.2% of STEMI patients receive thrombolysis [23], 41% of STEMI patients in India [24], 44.7% in Cape Town [18], 59% in Iran [25], 62% in Kenya [26] and 27% at a tertiary-care hospital in Sri Lanka [27]. Our study also compares well with studies from first world countries such as Scotland [28]. A study done locally at the Eric Williams Medical Sciences Complex in Trinidad in 2008 found that 78.4% of STEMI patients received thrombolytic therapy [29]. The significantly higher percentage of thrombolysis done in men and younger patients is a cause for concern since there is no policy to favour these groups. It may be because of earlier recognition of AMI and less distraction to reach hospital. In our study, of the 120 STEMI patients with available treatment time data, 57.5% received thrombolysis within 30?min. There was no association between time from arrival at the ED and receiving thrombolysis with sex, age, or ethnicity. EBG for emergency medical care (triaging, ECG acquisition time, door to thrombolysis time) of AMI is well recognized [30C32]. Reperfusion within the golden hour may abort 25% of AMIs [33]. The GUSTO trial revealed that only 7.3% of patients were treated within the first 30?min [34]. Timely interventions must be achieved to decrease coronary artery thrombus formation and prevent extension of existing thrombus, regardless of the type of intervention [35]. In fact, the risk of 1-year mortality is increased by 7.5% for each 30-min delay [35]. Although primary PCI is the superior treatment option, the value of thrombolysis.Electrocardiogram (ECG) and cardiac enzyme tests were universally performed, while echocardiogram was performed in 57.1% of patients and exercise stress test was performed occasionally. obtained from all confirmed AMI patients. Results Data were obtained from 1106 AMI patients who were predominantly male and of Indo Trinidadian descent. Emergency treatment included aspirin (97.2%), clopidogrel (97.2%), heparin (81.3%) and thrombolysis (70.5% of 505 patients with ST elevation MI), but none of the patients had primary angioplasty. Thrombolysis was higher among younger patients and in men. There were no differences in age, sex, and ethnicity in all other treatments. Of the 360 patients with recorded times, 41.1% arrived at the hospital within 4?h. The proportion of patients receiving thrombolysis (door to needle time) within 30?min was 57.5%. In-patient treatment medication included: aspirin (87.1%), clopidogrel (87.2%), beta blockers (76.5%), ACEI (72.9%), heparin (80.6%), and simvastatin (82.5%). Documentation of risk stratification, use of angiogram and surgical intervention, initiation of cardiac rehabilitation (CR), and information on behavioral changes were rare. Electrocardiogram (ECG) and cardiac enzyme tests were universally performed, while echocardiogram was performed in 57.1% of patients and exercise stress test was performed occasionally. Discharge treatment was limited to medication and referrals for investigations. Few patients were given lifestyle and activity advice and referred for CR. The in-hospital death rate was 6.5%. There was a significantly higher relative risk of in-hospital death for non-use of aspirin, clopidogrel, simvastatin, beta blockers, and heparin, but not ACE inhibitors and nitrates. Conclusions Medication usage was high among AMI patients. However, there was very minimal use of non-pharmacological measures. No differences were found in prescribed medication by age, sex, or ethnicity, with the exception of thrombolysis. angiotensin-converting enzyme, angiotensin II receptor blocker, electrocardiogram, exercise stress test, Global Registry of Acute Coronary Events, heart rate, non-ST-elevation myocardial infarction, percutaneous coronary intervention, ST-elevation myocardial infarction, Thrombolysis in Myocardial Infarction, Treatment not available or missing data Open in a separate window Fig. 2 Frequency of discharge treatment recommendation. (Legend) ACEi, angiotensin converting enzyme inhibitor; BP, blood pressure; DM, diabetes mellitus; MI, myocardial infarction Outcomes The average length of stay was 6.71??5.77?days CCR7 (range, 1C61?days). The majority of patients stayed between 3 and 8?days ( em n /em ?=?756, 70.9%) while a minority stayed ?3 or? ?8?days ( em n /em ?=?311, 29.1%). Less than 2 % of the patients suffered at least one of Isoacteoside the following complications: hypotension, arrhythmia, and bradyarrythmia requiring temporary pacing, recurrent ischemia or infarction, left ventricle failure, pericarditis, bleeding requiring transfusion, infection, and new neurologic event. Of the 1106 patients in the sample, 72 in-hospital deaths were recorded, which equates to an in-hospital death rate of 65 per thousand (46 male and 26 female, which is equivalent to an in-hospital death rate of 6.18 and 7.2% for males and females, respectively). Discussion In this resource limiting country, AMI treatment largely focused on pharmacological treatment. EBG emergency treatment comprising of aspirin (97.2%), clopidogrel (97.2%), and heparin (81.3%) was relatively high. Thrombolytic treatment was received by the majority (70.5%) of patients. The use of thrombolysis was significantly higher in men than in women; and in younger compared to older patients. The proportion of patients thrombolysed ( em n /em ?=?356/505, 70.5%) compares well or is even better than in other developing countries. In Sri Lanka, 70.2% of STEMI patients receive thrombolysis [23], 41% of STEMI patients in India [24], 44.7% in Cape Town [18], 59% in Iran [25], 62% in Kenya [26] and 27% at a tertiary-care hospital in Sri Lanka [27]. Our study also compares well with studies from first world countries such as Scotland [28]. A study done locally at the Eric Williams Medical Sciences Complex in Trinidad in 2008 found that 78.4% of STEMI patients received thrombolytic therapy [29]. The significantly higher percentage of thrombolysis done in men and younger patients is a cause for concern since there is no policy to favour these groups. It may be because of earlier recognition of AMI and less distraction to reach hospital. In our study, of the 120 STEMI patients with Isoacteoside available treatment time data, 57.5% received thrombolysis within 30?min. There was no association between time from arrival at.