Channelling regional registries for optimization of cardiac care: lessons from around the world

This editorial refers to ‘Presentation, management, and outcomes of 25 748 acute coronary syndrome admissions in Kerala, India: results from the Kerala ACS Registry’†, by P.P. Mohanan et al. , on page 121 The epidemiology of cardiac disease is undergoing a steady transformation, with a small but steady decline in cardiac mortality in the western world while the prevalence and impact of coronary artery disease (CAD) continue to increase in middle income and low income countries.1 This is especially true in south Asia where CAD often manifests at an early age with profound societal and economic implications.2Mohanan and colleagues now describe the results of the Kerala ACS Registry.3 Kerala, a picturesque state in south India, has some of the best health statistics in the Indian subcontinent, with high life expectancy, low infant mortality, and high literacy. It, however, has not been immune to the increasing incidence and prevalence of CAD that has accompanied India's economic transformation.4 The Kerala Chapter of the Cardiological Society of India is to be applauded for developing this collaborative registry to study the quality of care and outcomes associated with acute coronary syndromes (ACS). The investigators identified 185 hospitals in the state that provided care to patients with ACS and, of these, 125 hospitals submitted data to the registry. The registry enrolled patients at teaching institutions, private as well as government hospitals, and a sizeable number of rural hospitals (40%), thus increasing the generalizability of their findings. Fewer than a quarter of the institutions (22%) had a cardiac catheterization laboratory on site, while 58% had a cardiologist on staff. The patients enrolled in the study were more likely to be younger and to present with ST-elevation myocardial infarction (STEMI) compared with those in the registry data from developed countries. The use of …