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Dropping risk stratification with subsequent treatment-risk paradox in non ST elevation acute coronary syndromes: a clinical audit in Iraq

BMC health services research, 2021-09, Vol.21 (1), p.1015-1015, Article 1015 [Peer Reviewed Journal]

2021. The Author(s). ;COPYRIGHT 2021 BioMed Central Ltd. ;2021. This work is licensed under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. ;The Author(s) 2021 ;ISSN: 1472-6963 ;EISSN: 1472-6963 ;DOI: 10.1186/s12913-021-07034-7 ;PMID: 34565377

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  • Title:
    Dropping risk stratification with subsequent treatment-risk paradox in non ST elevation acute coronary syndromes: a clinical audit in Iraq
  • Author: Dakhil, Zainab Atiyah ; Farhan, Hasan Ali
  • Subjects: Acute coronary syndrome ; Acute Coronary Syndrome - diagnosis ; Acute Coronary Syndrome - epidemiology ; Acute Coronary Syndrome - therapy ; Acute coronary syndromes ; Aged ; Angina pectoris ; Audit ; Audits ; Cardiogenic shock ; Cardiology ; Cardiovascular disease ; Care and treatment ; Clinical Audit ; Coronary Angiography ; Decision making ; Development and progression ; Diagnosis ; Electrocardiography ; Female ; Guideline adherence ; Health risk assessment ; Healthcare policy ; Heart attacks ; Heart failure ; Humans ; Intubation ; Iraq ; Male ; Management ; Methods ; Middle Aged ; Middle East ; Patients ; Prospective Studies ; Risk Assessment ; Risk factors ; Risk scores ; Statistical analysis ; Triage (Medicine)
  • Is Part Of: BMC health services research, 2021-09, Vol.21 (1), p.1015-1015, Article 1015
  • Description: Risk stratification is the cornerstone in managing patients with Non-ST Elevation Acute Coronary Syndromes (NSTE-ACS) and can attenuate the unjustified variability in treatment and guide the intervention decision notwithstanding its impact on better healthcare resources use. This study sought to disclose real adherence to guidelines in risk stratification of NSTE-ACS patients and in adopting intervention decision in practice. Multicentre prospective study recruited NSTE-ACS patients. Baseline characteristics were collected, TIMI (Thrombolysis in Myocardial Infarction) and GRACE (Global Registry of Acute Coronary Events) scores were calculated, management strategy as well as timing to intervention were recorded. n. = 150, 72% of them were males, mean age was (59 ± 12.32) years. TIMI score was calculated in 5.3% of patients with none of them had GRACE score calculated. Invasive strategy was adopted in 85.24 and 82.7% of low GRACE and TIMI risk categories respectively, while invasive approach used in 42.85 and 40% of high GRACE and TIMI risk categories respectively. The immediate intervention in less than 2 hours was more to be used in low-risk categories while the high-risk and very high-risk patients whom were managed invasively were catheterized within >72 h; or more frequently to be non-catheterized at all. Sixty percent of those with acute heart failure, 80.76% of those with ongoing chest pain, 85% of those with dynamic ST changes same as 80% of those with cardiogenic shock were treated conservatively. Using multivariable analysis older age, ongoing chest pain and cardiogenic shock predicted conservative approach. There is striking underuse of risk scores in practice that can contribute to treatment-risk paradox in managing NSTE-ACS in form of depriving those with higher risk from invasive strategy despite being the most beneficiaries. The paradox did not only involve the very high-risk patients but also the very high-risk criteria like ongoing chest pain and cardiogenic shock predicted conservative approach, this highlights that the entire approach to patients with NSTE-ACS should be reconsidered, regardless of the use of risk scores in clinical practice. Audit programs activation in middle eastern countries can inform policymakers to put a limit to the treatment-risk paradox for better cardiovascular care and outcomes.
  • Publisher: England: BioMed Central Ltd
  • Language: English
  • Identifier: ISSN: 1472-6963
    EISSN: 1472-6963
    DOI: 10.1186/s12913-021-07034-7
    PMID: 34565377
  • Source: GFMER Free Medical Journals
    MEDLINE
    PubMed Central
    Springer Nature OA/Free Journals
    ROAD: Directory of Open Access Scholarly Resources
    ProQuest Central
    DOAJ Directory of Open Access Journals
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