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Management of acute coronary syndrome in a tertiary care general medical unit in Sri Lanka: how closely do we follow the guidelines?
Author(s) -
Rajapakse S.,
Rodrigo P.C.,
Selvachandran J.
Publication year - 2010
Publication title -
journal of clinical pharmacy and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.622
H-Index - 73
eISSN - 1365-2710
pISSN - 0269-4727
DOI - 10.1111/j.1365-2710.2009.01115.x
Subject(s) - medicine , clopidogrel , streptokinase , acute coronary syndrome , thrombolysis , myocardial infarction , coronary care unit , percutaneous coronary intervention , aspirin , observational study , emergency medicine , sri lanka , ethnology , south asia , history
Summary Background and objectives: Acute coronary syndrome (ACS) is a leading cause of death. Correct implementation of evidence‐based guidelines should improve outcome. We conducted this study to determine to what extent management of ACS in a tertiary care medical ward in Sri Lanka adhered to current guidelines. Study methods: This prospective observational study was carried out in the University Medical Unit of the National Hospital, Colombo, Sri Lanka, for a 5‐month period commencing April 2008. All patients presenting with ACS to the unit were included. Results: During the period of study, there were 101 admissions of confirmed ACS. Thirty‐one (30·6%) and 40 (39·6%) patients had not received the required correct loading dose of aspirin and clopidogrel, respectively. There were 34 cases of ST‐elevation myocardial infarction (STEMI); 26 patients were eligible for thrombolysis and streptokinase was given to 22 (84·6%). The rest were treated with low‐molecular‐weight heparin (LMWH). Of the 67 patients who did not have STEMI, 66 received the correct dose of LMWH. Fifty‐two patients (51·4%) were started on a β‐blocker at presentation. None of the patients received intravenous β‐blockers. Seventy‐four patients (73·2%) were started on either an angiotensin‐converting enzyme inhibitor or an angiotensin receptor blocker on presentation. None of the patients underwent primary percutaneous intervention. Conclusion: Adherence to guidelines is limited by lack of funds and resources in our setting; however, attention must be paid to non‐costly easily correctable deficits.