Browsing by Subject "Acute coronary syndrome"

Background: Acute coronary syndrome (ACS) is a rare diagnosis in sub-Saharan Africa, but patient and physician-related factors that may contribute to under-diagnosis are poorly understood. Methods: A community survey was performed of adults in northern Tanzania, and respondents were asked to describe symptoms of ACS, personal healthcare-seeking preferences for chest pain, and perceptions of self-risk. A retrospective chart review was conducted at a referral hospital in northern Tanzania to determine rates of various diagnoses among admitted adults over a six-month period. A prospective observational study was conducted in the emergency department, and diagnostic workups, treatments, and diagnoses for adults with chest pain or shortness of breath were recorded. Results: Of 718 survey respondents, 277 (38.6%) stated they would present to a hospital for chest pain and 115 (16.0%) were able to identify a conventional ACS symptom. Retrospectively, ACS accounted for 9 (0.3%) adult admissions, whereas heart failure accounted for 294 (12.2%) admissions. Prospectively, among 339 adults presenting with chest pain or shortness of breath, 170 (50.1%) received an electrocardiogram, 9 (2.7%) underwent cardiac biomarker testing, and 6 (1.8%) were diagnosed with ACS. Conclusions: In northern Tanzania, community awareness of ACS symptoms is low and only a minority of adults would present to a hospital for chest pain. Full diagnostic workups are rare among patients with symptoms of possible ACS, and ACS is a rare diagnosis.

Introduction: Acute coronary syndromes (ACS) result in significant morbidity and mortality in low-and-middle-income countries (LMICs). Fifty percent of deaths in this region are from a cardiac etiology. Not much is known about the epidemiology of ACS in Brazil. Our aim was to describe the correlation between social determinants of health and access-to-care markers as related to ACS mortality and its geographic distribution in the country. Methods: Using the Brazilian National Health Database (DATASUS) and other nationally aggregated data sources, socioeconomic (SE) parameters, cardiovascular risk (CV) factors and an accessibility index for high complexity cardiac care centers (with hemodynamic monitoring and cardiac interventions) were obtained. To account for spatial dependency, geographic weighted regression (GWR) analysis was performed for all the predictor variables with respect to the outcome of deaths. Results: There were 776,449 ACS-related deaths from 2012 to 2018. The highest ACS mortality rate was in the South region of Brazil (104.7 per 100,000 population). The GWR analysis showed regional variability of socioeconomic factors as correlated with ACS mortality. A low accessibility-index in the North and Northeast regions of Brazil was strongly associated with ACS deaths. Conclusions: Spatial analysis allows for estimation of the local heterogeneity in the relationship between SE components, CV risk factors and access-to-care markers as related to ACS mortality. Such analyses allow for improved understanding of the burden of ACS in Brazil.