Utilization of evidence-based therapy for acute coronary syndrome in high-income and low/middle-income countries.
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.
Divisions of Cardiology and Clinical Epidemiology, Jewish General Hospital, Lady Davis Institute for Medical Research, McGill University, Montreal, Quebec, Canada.
Avi
A
Shimony
Divisions of Cardiology and Clinical Epidemiology, Jewish General Hospital, Lady Davis Institute for Medical Research, McGill University, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.
Sonia M
SM
Grandi
Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada; Division of Clinical Epidemiology, McGill University Health Centre, Montreal, Quebec, Canada; Division of General Internal Medicine, McGill University Health Centre, Montreal, Quebec, Canada.
Louise
L
Pilote
Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada; Division of Clinical Epidemiology, McGill University Health Centre, Montreal, Quebec, Canada.
Lawrence
L
Joseph
Department of Social and Preventive Medicine, Université de Montréal, Montreal, Quebec, Canada.
Jennifer
J
O'Loughlin
Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.
Gilles
G
Paradis
Multidisciplinary Cardiology Department, Quebec Heart-Lung Institute, Quebec City, Quebec, Canada.
Stéphane
S
Rinfret
Isfahan Cardiovascular Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
Nizal
N
Sarrafzadegan
Interactive Research and Development Center, Karachi, Pakistan.
Nasreen
N
Adamjee
Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.
Rakesh
R
Yadav
Cardiac Thrombosis Research Unit, Department of Cardiology A, Fattouma Bourguiba University Hospital, Monastir, Tunisia.
Habib
H
Gamra
Division of Cardiology, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada.
Jean G
JG
Diodati
Divisions of Cardiology and Clinical Epidemiology, Jewish General Hospital, Lady Davis Institute for Medical Research, McGill University, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada. Electronic address: mark.eisenberg@mcgill.ca.
Mark J
MJ
Eisenberg
D054058:Acute Coronary Syndrome / Q000188:drug therapy / Q000453:epidemiology / Q000628:therapy*; D000328:Adult; D000368:Aged; D015897:Comorbidity; D003906:Developing Countries; D004311:Double-Blind Method; D050171:Dyslipidemias / Q000453:epidemiology; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D015912:Thrombolytic Therapy / Q000706:statistics & numerical data*