Projects

Project Description

Introduction

Coronary heart disease mortality rates are very high in India. Structured data capture of acute coronary syndromes is the first step in improvement of quality of treatment. Previous registries from India lacked geographical representation and long term follow up data.

Objectives

To evaluate management patterns of ACS patients in India and to correlate rates of optimal patient care with outcomes.

Methods

The feasibility study was undertaken under the aegis of ICMR in 13 public and private hospitals across India and recruited 1515 confirmed ACS patients ≥ 18 years. A web based secure electronic data capture and management system was developed to expedite data collection from dispersed sites. Data on ACS case load, facilities at hospital, patient demographics, medical history, clinical characteristics, laboratory and electrocardiography findings, treatment approaches and outcomes was captured by study sites and sent to a centralized database for further processing and reporting.

Results

Of the 1515 ACS patients, 46.3% had STEMI, had a mean age of 58 [SD 11.5 ] years, 25% were ≤50 years, 77% were males and 65% were from lower middle and poor social class. Tobacco consumption (55.3%), hypertension (45%) and diabetes (32.5%) were the most prevalent risk factors. The median time from onset of symptoms to hospital was 900 min whereas to first medical contact was 150 min. The door to needle /balloon time was less than 30 min and 90 min in only 33% and 17% of patients respectively. About 97% of patients received aspirin, clopidogrel and statins, 77.5% beta blockers and 64.6% ACE inhibitors. Thrombolytics were used in 30.9% and percutaneous coronary intervention was done in 44.6% of STEMI patients. Eight percent of ACS patient died within six months of acute event.

Conclusion

Establishment of multicentric hospital based registry of ACS through a web based system in India is feasible. As the system matures and gets greater acceptability among caregivers, the data may help in not only standardizing 'Best Practices' but also rating institutions. The registry has a great potential for evolving low cost methods of ACS care across institutions with varying infrastructure and capacities. A nationwide pilot study has been planned.