ARTICOLI ORIGINALI   

Gazzetta Medica Italiana Archivio per le Scienze Mediche 2014 July-August;173(7-8):377-82

Copyright © 2014 EDIZIONI MINERVA MEDICA

lingua: Inglese

The quality of care in acute coronary syndrome and its association with mortality in the United Arab Emirates: data from the Gulf RACE

Shehab A. ¹, Yasin J. ¹, Al-Dabbagh B. ², Hashim M. J. ³, Almahmeed W. ⁴, Bustani N. ⁴, Agrawal A. ⁵, Yusufali A. H. ⁶, Wassef A. ⁷, Alnaeemi A. ⁸, Abdulle A. ¹

¹ Department of Internal Medicine, College of Medicine and Health Sciences, UAE University, Al Ain, United Arab Emirates; ² Department of Chemistry, College of Science, UAE University, Al Ain, United Arab Emirates; ³ Department of Family Medicine, College of Medicine and Health Sciences, UAE University, Al Ain, United Arab Emirates; ⁴ Heart and Vascular Institute, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates; ⁵ Department of Cardiology, Fujairah Hospital, Fujairah, United Arab Emirates; ⁶ Dubai Heart Centre, Dubai Hospital, Dubai, United Arab Emirates; ⁷ Obaidallah Hospital, MOH, Ras Al‑Khaimah, United Arab Emirates; ⁸ Zayed Military Hospital, Abu Dhabi, United Arab Emirates

AIM: Objective of the present study was to evaluate the quality of care and outcome in patients with acute coronary syndrome (ACS) according to international guidelines.
METHODS: We used data from the Gulf Registry of Acute Coronary Events (Gulf RACE). A sub sample of 1693 patients from the United Arab Emirates (UAE) was analyzed.
RESULTS: In all ACS patients, aspirin and statins were adequately prescribed on admission and at discharge, whereas, the treatment with angiotensin-converting enzyme inhibitor (ACEI)/angiotensin II receptor blocker (ARIIB), clopidogrel, and beta-blockers (BB), increased at discharge according to guideline-recommended treatment. The use of clopidogrel and BB at discharge was significantly different in the three ACS classes. Patients who were receiving all five guideline-recommended drugs, were mainly males (P=0.0001) and more in the age groups of (< 55 and 55-74 years). Smokers were better treated than non-smokers, but patients with prior coronary artery disease (CAD) did not receive optimal treatment. Mortality was significantly (P=0.0001) less among the subjects who received adequate treatment (0.1%) than those who did not (4.3%). Multivariate regression analysis, showed that age [adjusted OR: 1.051; 95% CI: 1.015-1.089; P=0.005] and the use of all five guideline-recommend drugs [adjusted OR: 0.042; 95% CI: 0.005-0.319; P=0.002 (protective effect)] were independent predictors of death.
CONCLUSION: The quality of care for patients with ACS in the UAE seems to be modest and the use of guideline-recommended drugs is suboptimal. The need for improved care, particularly, among elder patients, and adherence to guideline-recommended treatment is highlighted.