title: Challenges and solutions in medically managed ACS in the Asia-Pacific region: expert recommendations from the Asia-Pacific ACS Medical Management Working Group.
abstract: Acute coronary syndromes (ACS) remain a leading cause of mortality and morbidity in the Asia-Pacific (APAC) region. International guidelines advocate invasive procedures in all but low-risk ACS patients; however, a high proportion of ACS patients in the APAC region receive solely medical management due to a combination of unique geographical, socioeconomic, and population-specific barriers. The APAC ACS Medical Management Working Group recently convened to discuss the ACS medical management landscape in the APAC region. Local and international ACS guidelines and the global and APAC clinical evidence-base for medical management of ACS were reviewed. Challenges in the provision of optimal care for these patients were identified and broadly categorized into issues related to (1) accessibility/systems of care, (2) risk stratification, (3) education, (4) optimization of pharmacotherapy, and (5) cost/affordability. While ACS guidelines clearly represent a valuable standard of care, the group concluded that these challenges can be best met by establishing cardiac networks and individual hospital models/clinical pathways taking into account local risk factors (including socioeconomic status), affordability and availability of pharmacotherapies/invasive facilities, and the nature of local healthcare systems. Potential solutions central to the optimization of ACS medical management in the APAC region are outlined with specific recommendations.
authors: Peking University First Hospital, Beijing, China. Electronic address: huoyong@263.net.cn.
authors: Yong
authors: Y
authors: Huo
authors: University of Western Australia, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia. Electronic address: peterlthompson@bigpond.com.
authors: Peter
authors: P
authors: Thompson
authors: Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
authors: Wacin
authors: W
authors: Buddhari
authors: Zhongshan Hospital, Fudan University, Shanghai, China.
authors: Junbo
authors: J
authors: Ge
authors: Wellington Cardiovascular Research Group and School of Biological Sciences, Victoria University, Wellington, New Zealand.
authors: Scott
authors: S
authors: Harding
authors: Department of Medicine, Taiping Hospital, Taiping, Malaysia.
authors: Letchuman
authors: L
authors: Ramanathan
authors: University of the Philippines, Philippine General Hospital-Section of Cardiology, Manila, Philippines.
authors: Eugenio
authors: E
authors: Reyes
authors: Department of Cardiology - Vascular Medicine, Faculty of Medicine, University of Indonesia and National Cardiovascular Center, Harapan Kita, Indonesia.
authors: Anwar
authors: A
authors: Santoso
authors: Kwong Wah Hospital, Kowloon, Hong Kong.
authors: Li-Wah
authors: LW
authors: Tam
authors: Kerala Institute of Medical Sciences, Kerala, India.
authors: Govindan
authors: G
authors: Vijayaraghavan
authors: Mackay Memorial Hospital, Mackay Medical College, New Taipei City, Taiwan.
authors: Hung-I
authors: HI
authors: Yeh
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy* / Q000453:epidemiology* / Q000601:surgery; D001208:Asia / Q000453:epidemiology; D006801:Humans; D044349:Oceania / Q000453:epidemiology; D062645:Percutaneous Coronary Intervention; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic
chemical_list: D010975:Platelet Aggregation Inhibitors
keywords: Acute coronary syndromes; Asia-Pacific; Conservative; Medical management; Myocardial infarction