Challenges and solutions in medically managed ACS in the Asia-Pacific region: Expert recommendations from the Asia-Pacific ACS Medical Management Working Group. (15th March 2015)

• Record Type: Journal Article
• Authors: Huo, Yong; Thompson, Peter; Buddhari, Wacin; Ge, Junbo; Harding, Scott; Ramanathan, Letchuman; Reyes, Eugenio; Santoso, Anwar; Tam, Li-Wah; Vijayaraghavan, Govindan; Yeh, Hung-I
• Is Part Of: International journal of cardiology. Volume 183(2015)
• Page Start: 63
• Page End: 75
• Publication Date: 2015-03-15
• Subjects: ACACIA Australian Acute Coronary Syndromes Prospective Audit -- ACCORD ACute CORonary syndromes Descriptive study -- ACCF American College of Cardiology Foundation -- ACEi angiotensin-converting enzyme inhibitor -- ACS acute coronary syndromes -- ADPi adenosine diphosphate inhibitor -- AHA American Heart Association -- ANZACS QI All New Zealand ACS Quality Improvement -- APAC Asia-Pacific -- ARB angiotensin receptor blockers -- BB beta-blockers -- BRIG Bridging the Gap -- CABG coronary artery bypass graft -- CHD coronary heart disease -- CKD chronic kidney disease -- CPACS Clinical Pathway for Acute Coronary Syndrome in China -- CRUSADE Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA guidelines -- CVD cardiovascular disease -- CURE Clopidogrel in Unstable Angina to Prevent Recurrent Events -- DAPT dual antiplatelet therapy -- ECG electrocardiogram -- EPICOR long-tErm follow-uP of antithrombotic management patterns In acute CORonary syndrome patients -- ER emergency room -- GP glycoprotein -- ESC European Society of Cardiology -- GRACE Global Registry of Acute Coronary Events -- HOTPR high on-treatment platelet reactivity -- JAC Jakarta ACS -- LDL-C low-density lipoprotein cholesterol -- LMWH low molecular weight heparin -- LV left ventricular -- MI myocardial infarction -- NCVD National Cardiovascular Disease Database -- NSTEMI non-ST-elevation myocardial infarction -- PCI percutaneous coronary intervention -- PLATO PLATelet inhibition and patient Outcomes -- PURE Prospective Urban Rural Epidemiology -- PURSUIT platelet glycoprotein IIb/IIIa in unstable angina: receptor suppression using integrilin therapy -- STEMI ST-elevation myocardial infarction -- T-ACCORD Taiwan Acute Coronary Syndrome Descriptive Registry -- TIMI Thrombolysis in Myocardial Infarction -- TSOC Taiwan Society of Cardiology -- TNK teneceteplase -- tPA tissue plasminogen activator -- UA unstable angina -- UF unfractionated heparin; Acute coronary syndromes -- Asia-Pacific -- Medical management -- Conservative -- Myocardial infarction; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2014.11.195
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Acute coronary syndromes (ACS) remain a leading cause of mortality and morbidity in the Asia-Pacific (APAC) region. International guidelines advocate invasive procedures in all but low-risk ACS patients; however, a high proportion of ACS patients in the APAC region receive solely medical management due to a combination of unique geographical, socioeconomic, and population-specific barriers. The APAC ACS Medical Management Working Group recently convened to discuss the ACS medical management landscape in the APAC region. Local and international ACS guidelines and the global and APAC clinical evidence-base for medical management of ACS were reviewed. Challenges in the provision of optimal care for these patients were identified and broadly categorized into issues related to (1) accessibility/systems of care, (2) risk stratification, (3) education, (4) optimization of pharmacotherapy, and (5) cost/affordability. While ACS guidelines clearly represent a valuable standard of care, the group concluded that these challenges can be best met by establishing cardiac networks and individual hospital models/clinical pathways taking into account local risk factors (including socioeconomic status), affordability and availability of pharmacotherapies/invasive facilities, and the nature of local healthcare systems. Potential solutions central to the optimization of ACS medical management in the APAC region are outlined with specific recommendations.