title: Time to treatment in patients of suspected acute coronary syndrome in Pakistan: a clinical audit.
abstract: OBJECTIVE
  Evaluate time to treatment (TT) in suspected acute coronary syndrome (ACS) patients in the Emergency Department (ED) in Pakistan.
  
  
  METHODS
  In this clinical audit, medical records of adult patients with suspicion of ACS visiting the ED of a tertiary care facility in Karachi from January to March of 2012 were reviewed and evaluated according to benchmarks from American College of Cardiology/American Heart Association guidelines.
  
  
  RESULTS
  Study included 230 patients, of which 62.6% were males (n = 144). Physicians saw most patients (74.1%) in ≤10 min (min) of ED triage. ECG was performed in ≤10 min in 93 (47.7%) patients. Of the 207 patients being prescribed Aspirin, 41.9% received it in ≤10 min. Of 155 patients who were prescribed anti-coagulants (e.g., heparin), 32.9% received them in 10 min. Half of the patients requiring primary coronary intervention underwent the procedure within 90 min.
  
  
  CONCLUSIONS
  Findings warrant exploring interventions to improve TT for ACS care in resource-limited settings.
authors.affiliation: Department of Emergency Medicine, Aga Khan University, Karachi, Pakistan. Electronic address: munawar.khursheed@aku.edu.
authors.forename: Munawar
authors.initials: M
authors.lastname: Khursheed
authors.affiliation: Department of Emergency Medicine, Aga Khan University, Karachi, Pakistan.
authors.forename: Jabeen
authors.initials: J
authors.lastname: Fayyaz
authors.affiliation: Department of Emergency Medicine, Aga Khan University, Karachi, Pakistan.
authors.forename: Asher
authors.initials: A
authors.lastname: Feroze
authors.affiliation: Department of Emergency Medicine, Aga Khan University, Karachi, Pakistan.
authors.forename: Nishi
authors.initials: N
authors.lastname: Shakeel
authors.affiliation: Department of Emergency Medicine, Aga Khan University, Karachi, Pakistan; Sunnybrook Health Sciences Centre Research Institute, Toronto, Canada.
authors.forename: Junaid A
authors.initials: JA
authors.lastname: Bhatti
mesh_terms: D054058:Acute Coronary Syndrome / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001241:Aspirin / Q000627:therapeutic use*; D054869:Clinical Audit; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010154:Pakistan; D012189:Retrospective Studies; D061665:Time-to-Treatment; D014218:Triage
chemical_list: D001241:Aspirin
keywords: Acute coronary syndrome; Audit; Emergency department; Pakistan; Quality improvement