title: Acute coronary syndrome in the Asia-Pacific region.
abstract: More than 4.2 billion inhabitants populate the Asia-Pacific region. Acute coronary syndrome (ACS) is now a major cause of death and disability in this region with in-hospital mortality typically exceeding 5%. Yet, the region still lacks consensus on the best approach to overcoming its specific challenges in reducing mortality from ACS. The Asia-Pacific Real world evIdenCe on Outcome and Treatment of ACS (APRICOT) project reviewed current published and unpublished registry data, unmet needs in ACS management and possible approaches towards improving ACS-related mortality in the region. There was striking heterogeneity in the use of invasive procedures, pharmacologic practice (hospitalization/post-discharge), and in short- and long-term clinical outcomes across healthcare systems; this heterogeneity was perceived to be far greater than in Western Europe or the United States. 'Benchmark' short-term clinical outcomes are preferred over long-term outcomes due to difficulties in follow-up, recording and maintenance of medication adherence in a geographically large and culturally diverse region. Key 'barriers' towards improving outcomes include patient education (pain awareness, consequences of missing medication and secondary prevention), geographical landscape (urban vs. metropolitan), limited long-term adherence to guideline-based management and widespread adoption of cost-based rather than value-based healthcare systems. Initiatives to overcome these barriers should include implementation of pre-hospital management strategies, toolkits to aid in-hospital treatment, greater community outreach with online patient/physician education and telemedicine, sustainable economic models to improve accessibility to effective pharmacotherapies and the acquisition of high-quality 'real-world' regional data to tailor secondary prevention initiatives that meet the unique needs of countries in this region.
authors.affiliation: National University Heart Centre, Singapore. Electronic address: mark_chan@nuhs.edu.sg.
authors.forename: Mark Y
authors.initials: MY
authors.lastname: Chan
authors.affiliation: Beijing AnZhen Hospital, Capital Medical University, Beijing, China.
authors.forename: Xin
authors.initials: X
authors.lastname: Du
authors.affiliation: University of Melbourne, Melbourne, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Eccleston
authors.affiliation: Beijing AnZhen Hospital, Capital Medical University, Beijing, China.
authors.forename: Changsheng
authors.initials: C
authors.lastname: Ma
authors.affiliation: West Fort Hospital, Thrissur, India.
authors.forename: Padinhare P
authors.initials: PP
authors.lastname: Mohanan
authors.affiliation: Juntendo University School of Medicine, Tokyo, Japan.
authors.forename: Manabu
authors.initials: M
authors.lastname: Ogita
authors.affiliation: Shin Kong Wu Ho-Su Memorial Hospital, Taiwan.
authors.forename: Kou-Gi
authors.initials: KG
authors.lastname: Shyu
authors.affiliation: The Chinese University of Hong Kong (Prince of Wales Hospital), Hong Kong.
authors.forename: Bryan P
authors.initials: BP
authors.lastname: Yan
authors.affiliation: Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea. Electronic address: goodoctor@naver.com.
authors.forename: Young-Hoon
authors.initials: YH
authors.lastname: Jeong
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000208:ethnology* / Q000628:therapy*; D001208:Asia / Q000208:ethnology; D006801:Humans; D009026:Mortality / Q000639:trends; D010140:Pacific Ocean / Q000208:ethnology; D010353:Patient Education as Topic / Q000639:trends; D012042:Registries
keywords: Acute coronary syndromes; Antiplatelet; Asia-Pacific; Medical management; Myocardial infarction