Background Ischaemic heart disease is the leading cause of in-hospital mortality in Sri Lanka. Acute Coronary Syndrome Sri Lanka Audit Project (ACSSLAP) is the first national clinical-audit project that evaluated patient characteristics, clinical outcomes and care provided by state-sector hospitals.
Methods ACSSLAP prospectively evaluated acute care, in-hospital care and discharge plans provided by all state-sector hospitals managing patients with ACS. Data were collected from 30 consecutive patients from each hospital during 2–4 weeks window. Local and international recommendations were used as audit standards.
Results Data from 87/98 (88.7%) hospitals recruited 2177 patients, with 2116 confirmed as having ACS. Mean age was 61.4±11.8 years (range 20–95) and 58.7% (n=1242) were males. There were 813 (38.4%) patients with unstable angina, 695 (32.8%) with non-ST-elevation myocardial infarction (NSTEMI) and 608 (28.7%) with ST-elevation myocardial infarction (STEMI). Both STEMI (69.9%) and NSTEMI (61.4%) were more in males (P<0.001). Aspirin, clopidogrel and statins were given to over 90% in acute setting and on discharge. In STEMI, 407 (66.9%) were reperfused; 384 (63.2%) were given fibrinolytics and only 23 (3.8%) underwent primary percutaneous coronary intervention (PCI). Only 42.3 % had thrombolysis in <30 min and 62.5% had PCI in <90 min. On discharge, beta-blockers and ACE inhibitors/angiotensin II receptor blockers were given to only 50.7% and 69.2%, respectively and only 17.6% had coronary interventions planned.
Conclusions In patients with ACS, aspirin, clopidogrel and statin use met audit standards in acute setting and on discharge. Vast majority of patients with STEMI underwent fibrinolyisis than PCI, due to limited resources. Primary PCI, planned coronary interventions and timely thrombolysis need improvement in Sri Lanka.
- acute coronary syndromes
- acute mocardial infarction
- global health care delivery
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Contributors PG, RE, CW, GKSG conceptualised the study, PG, VRB, PR, MW, DSW, MS, TW and SS developed the proposal and obtained approvals, VRB, PR, MW, DSW, MS, TW, US assisted in data collection, data entry and analysis of results, PG, PR and VRB developed the manuscript, all authors read and revised the manuscript and approved the final manuscript.
Funding The Non-Communicable Disease (NCD) unit of the Ministry of Healthcare and Nutrition funded the study.
Competing interests None declared.
Ethics approval Ethics approval was obtained from Ethics Review Committee of Faculty of Medicine, University of Colombo. Administrative approvals were obtained from the Director General of Health Services, Provincial Directors, Directors of the respective hospitals of the Ministry of Health and the consultants of each ward.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Other additional details on demographic data, additional treatments given and detailed analysis of data from different provinces are available with the investigators. These will be used in future publications.