Clinical Profile and Outcomes of ACS Patients in Bangladesh: Insights from a National Facility-Based Registry

Introduction

One-third of annual deaths in Bangladesh are from cardiovascular diseases. Acute Coronary Syndrome (ACS) has various presentations, severity, and treatment options. Information obtained from the ACS registry will help in improved patient management and appropriate planning. This prospective observational study aimed to understand treatment and outcomes, and their associated factors, among Bangladeshi adult ACS patients by establishing a facility-based registry.

Methods

The national ACS registry was established in six tertiary-level hospitals—equally representing government and private facilities—across the metropolitan cities of Dhaka, Sylhet, and Chattagram, in collaboration with the Non-communicable Disease Control Programme (NCDC) of the Directorate General of Health Services, Ministry of Health. Patients admitted with a diagnosis of ACS in the selected hospitals were interviewed and their medical records were reviewed. An Android-based app was developed to collect information on socio-demographic characteristics, ACS risk factors, presenting features, treatment-seeking behavior, provided management, in-hospital complications, and immediate outcomes. The long-term outcomes were collected via telephonic follow-up after a minimum of 6 months passed from enrollment.

Results

A total of 29,029 patients were enrolled in the registry, and 28,645 had a confirmed diagnosis of ACS; 41.6% STEMI, 38.7% NSTEMI, and 20.7% unstable angina. The majority were male (68.3%), with a mean age of 56.4 ± 12.1 years, and 79% were aged ≥46 years. On admission, 58.1% were hypertensive and 46.4% were diabetic; 60.7% reported a history of tobacco use, and 27.3% had a family history of heart disease. Almost all patients (98.5%) were symptomatic, most commonly presenting with excessive sweating (87.8%) and chest pain or discomfort (73.1%). One-quarter of patients initially sought care at secondary-level or lower public health facilities or private chambers; 8.8% did not receive an initial loading dose of antiplatelet therapy at first contact facility. The majority (75.9%) were treated conservatively with medical management; reperfusion therapy was used infrequently in hospitals below the tertiary level. During initial hospital stay, 32.3% of patients experienced at least one complication, and in-hospital mortality was 1.4%. To date, 78.% of enrolled patients have been contacted by telephone after an average of 10 months; 92.2% were successfully followed up; 86.6% were alive, and 14.5% required rehospitalization. Most of the deaths reported at long-term follow-up were attributed to cardiovascular causes.

Conclusion

Under-reporting of NSTEMI was presumed, which demands further research. The provision of cardiac marker testing and safe-affordable thrombolytics at primary healthcare facilities are recommended in addition to the awareness rising to control the rising burden of acute coronary syndrome and its complications in Bangladesh.