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The UP-Philippine General Hospital Acute Coronary Events at the Emergency Room Registry (UP PGH-ACER)
Jean D. Alcover, Ariel D. Valones, Felix Eduardo R. Punzalan and Eugene B. Reyes
Section of Cardiology, Department of Medicine, College of Medicine and
Philippine General Hospital, University of the Philippines Manila
Objectives. This study pilots the creation of a clinical registry for all patients admitted for Acute Coronary Syndromes(ACS) at the Philippine General Hospital (PGH) Emergency Room (ER).
Methods. This is a single-institution prospective observational study including all patients >18 years old admitted from September to October 2011 with suspected actue coronary syndromes. Abstraction of chart information using a data collection form was done. Patient's clinical data, medications received, and quality of care indicators were noted. The primary study outcome measure is the completeness of chart data quality indicators such as door-to-ECG time and door-to-needle time, and clinical profile of patients with ACS.
Results. Thirty patients were included, with equal numbers of males females, and a mean age of 59 years old. There were equal numbers of patients with STEMI (43%) and NSTEMI (43%). The most common risk factor was hypertension (72.4%) followed by smoking (34.48%). Around 20% are diabetics, and 31% have known lipid abnormalities or are on lipid-lowering agents. Around one third of the patients have had previous admissions for acute coronary events. Only two patients had angiographically confirmed CAD. The majority of patients assessed to have acute coronary syndromes (26 patients) were Killip Class I. Only one was cardiogenic shock upon admission. Temporal information such as time of first physician contact and time of drug administration was not available in more than half of the cases. While there is a high rate of physician compliance to guideline recommended therapies, temporal quality indicators sch as door-to-ECG time (2 hours) and door-to-needle time (3.5 hours) remain substandard. The rest of the patients presented beyond 12 hours of chest pain onset and were already chest pain free. Among those who were eligible for thrombolysis, 67% received thrombolytic therapy with streptokinase. No patient was given thrombolytic agent within 30 minutes upon admission to the emergency department. No patient underwent cardiac catheterization as the primary means of revascularization. Hence, door-to-balloon time could not be determined.
Conclusion. A standardized ACS pathway for adequate documentation of information is necessary for a complete and effective clinical registry for ACS must be set in place. Establishment of an efficient clinical registry must be a joint effort of all services involved in the care for these patients. Proper documentation in clinical charts of patients admitted at the PGH-ER needs to be improved. The quality indicators such as door-to-ECG and door-to-needle time were remarkably above the guideline recommended targets. The compliance for class 1 medications among patients admitted for ACS during the time of the study was optimal.
Keywords: Acute Coronary Syndrome, emergency room, compliance to guidelines, ACS pathway, clinical profile, quality indicators