Acute coronary syndrome in the Asia-Pacific region

被引:88
作者
Chan, Mark Y. [1 ]
Du, Xin [2 ]
Eccleston, David [3 ]
Ma, Changsheng [2 ]
Mohanan, Padinhare P. [4 ]
Ogita, Manabu [5 ]
Shyu, Kou-Gi [6 ]
Yan, Bryan P. [7 ]
Jeong, Young-Hoon [8 ]
机构
[1] Natl Univ Heart Ctr, Singapore, Singapore
[2] Capital Med Univ, Beijing AnZhen Hosp, Beijing, Peoples R China
[3] Univ Melbourne, Melbourne, Vic, Australia
[4] West Ft Hosp, Thnssur, India
[5] Juntendo Univ, Sch Med, Tokyo 113, Japan
[6] Shin Kong Wu Ho Su Mem Hosp, Taipei, Taiwan
[7] Chinese Univ Hong Kong, Prince Wales Hosp, Hong Kong, Hong Kong, Peoples R China
[8] Gyeongsang Natl Univ, Sch Med, Gyeongsang Natl Univ Hosp, Jinju, South Korea
关键词
Acute coronary syndromes; Asia-Pacific; Medical management; Antiplatelet; Myocardial infarction; ACUTE MYOCARDIAL-INFARCTION; DUAL ANTIPLATELET THERAPY; IN-HOSPITAL OUTCOMES; DRUG-ELUTING STENTS; ACHIEVING CARDIOVASCULAR HEALTH; TREATMENT PLATELET REACTIVITY; MULTICENTER RANDOMIZED-TRIAL; GENDER-BASED DIFFERENCES; CLINICAL-OUTCOMES; PRIMARY ANGIOPLASTY;
D O I
10.1016/j.ijcard.2015.04.073
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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 The Asia-Pacific Real world evIdenCe on Outcome and Treatment of ACS (APRICOT) project reviewed current published and unpublished registry data, unmet needs in ACS management and possible approaches towards improving ACS-related mortality in the region.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. (C) 2015 The Authors. Published by Elsevier Ireland Ltd.
引用
收藏
页码:861 / 869
页数:9
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