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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Utilization of evidence-based therapy for acute coronary syndrome in high-income and low/middle-income countries
American Journal of Cardiology, Volume 113, No. 5, Year 2014
Notification
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Description
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. © 2014 Elsevier Inc. All rights reserved.
Authors & Co-Authors
Shimony, Avi
Unknown Affiliation
Grandi, Sonia M.
Unknown Affiliation
Pilote, Louise
Unknown Affiliation
Joseph, Lawrence
Unknown Affiliation
O'Loughlin, Jennifer
Unknown Affiliation
Paradis, Gilles
Unknown Affiliation
Rinfret, Stéphane
Unknown Affiliation
Sarrafzadegan, Nizal S.
Unknown Affiliation
Adamjee, Nasreen
Unknown Affiliation
Yadav, Rakesh
Unknown Affiliation
Gamra, Habib
Unknown Affiliation
Diodati, Jean Gino
Unknown Affiliation
Eisenberg, Mark J.
Unknown Affiliation
Statistics
Citations: 26
Authors: 13
Affiliations: 11
Identifiers
Doi:
10.1016/j.amjcard.2013.11.024
ISSN:
00029149
e-ISSN:
18791913
Research Areas
Disability
Health System And Policy
Noncommunicable Diseases
Study Design
Randomised Control Trial
Case-Control Study
Study Locations
Tunisia