By 121 News
Chandigarh 30th Dec:- Cardiovascular disease is the leading cause of mortality worldwide with ischemic heart disease responsible for 144 deaths per lakh of population in India. The department of Cardiology is constantly trying to reduce the mortality in patients of acute coronary syndrome since 2001 onwards, this started initially in patients with cardiogenic shock with all co morbid diseases like diabetes mellitus, hypertension, chronic kidney disease, septicemia, and advanced age, who used to be very sick and have mortality to the tune of 70-90%. In many countries these patients were not included in the shock registry and research because these patients were not included in insurance reimbursement and there was lack of evidence in treating these patients. We tried to intervene in such patients with strategic and integrated approach, sometimes when the intervention is highly risky and complicated by getting informed high-risk consent by explaining pros and cons after taking all precautions and 360 degree approach. Consistently with our hard working and sincere efforts the mortality has progressively reduced. Our approach is to treat all patients including the sickest for real world registry of Acute Coronary Syndromes including patients with low socioeconomic status.
From 2003 onwards we have presented our data and evidence in medical literature nation and international conferences and many lectures inside our institute. A planned research with ethical clearance was started from 2007 onwards to see the trend of Cardiogenic Shock and Acute Coronary Syndromes.
Acute coronary syndrome mortality world-wide varies around 8% while in India it varies between 7 to 9%.
Initially the mortality in the overall ACS population was around 16% till 2012 including Cardiogenic Shock, which has gradually reduced to current mortality between 6 to 7%. In the group of patients with cardiogenic shock the mortality was 36% to 40% which has now been reduced to around 30% during 2018-2019. In patients with severe mitral regurgitation the mortality was initially around 55% which has reduced to current mortality of around 40%.
Approximately three-quarters of all global deaths due to cardiovascular diseases occur in low- and middle-income countries. Although the coronary artery disease (CAD) -related mortality has declined over the past few decades, the overall incidence of acute coronary syndrome (ACS) has increased significantly, owing to a multitude of factors, especially in less developed countries. A significant difference in the presentation of ACS in developing countries of Asia, Africa, and Latin America as compared with the developed countries is the delay in seeking medical care as a result of lack of awareness among patients and inadequate medical facilities. In spite of a considerable improvement in the outcome of patients with ACS globally, the mortality of those who present with Cardiogenic Shock (CS) remains as high as 40-60% even in the developed countries. While the randomized Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock (SHOCK) trial established a benefit of early revascularization compared with initial medical stabilization in patients with CS, a large proportion of the cohort presented early after symptom onset, with a median time to revascularization of 11 h from symptom onset and 5 h from the onset of shock. A delayed presentation after ST-elevation myocardial infarction (STEMI) is associated with extensive myocardial necrosis and worse outcomes. The occurrence of CS with end-organ hypoperfusion further impairs the prognosis. There is lack of data regarding patients presenting late after symptom onset (_12 h) with ST-elevation myocardial infarction and complicated by cardiogenic shock (CS-STEMI), and the optimal treatment strategies in these patients remain poorly defined. Given the large number of patients in low- and middle income countries with this profile, it is important to determine the optimum management strategy to improve their outcomes.
The summary of registry of ACS patient from our institute were given in the tabulated form below
The department was visited by various faculty including Prof C. Thomas Peter from Cedars- Sinai medical center, California one of the top Cardiology Institutes in the world and other faculty from Mayo clinic and reputed hospitals, they were impressed by our approach to the patient care and by our patient outcomes and they have even started following our methods of treatment in their hospitals.
Our aim is to achieve lower mortality world-wide by using well monitored, innovative and integrated approach in high risk cohorts of acute coronary syndromes using cost effective approaches. For this we have already started a multi-centric national Registry for patients with acute coronary syndrome and Cardiogenic shock. Through this Registry we will be sharing our experience and we will be guiding other centers across India to achieve lower mortality along with low cost in patients with acute coronary syndrome.
These are the directions for keeping your heart healthy-
1. Maintain regular activity, at least 150 minutes of weekly exercise of moderate intensity (try to distribute over 5 days);
2. Maintain stress free environment, which you can do by meditation, activities like yoga will help in both ways, by reducing stress and by exercising your body; for stress "the less the better"
a. Reduce sugar intake (free sugars like sweets, soft drinks, other sweetened beverages)
b. Increase whole foods (fresh fruits, vegetables, whole grains)
c. Good quality high protein diet (plant-based protein, If you are a non- vegetarian, can take non- frozen fish and non- red meat (poultry) products, egg white) / maintain normal Haemoglobin for better outcomes.
d. Avoid re- using oil multiple times and reduce overall oil usage
e. Reduce salt intake (reduces your blood pressure and heart failure symptoms)
3. Reducing blood pressure will decrease future occurrence of cardiovascular events; although different groups of patients will have different optimum levels of blood pressure (ask your physician for your optimum level)
4. Control blood sugars, optimal is to maintain HbA1C around 7% is also fine if you can't maintain strict control of blood sugars .Low blood sugar level is more dangerous then mild high blood sugars.
5. Absolutely avoid smoking, if you can't stop completely start by reducing day by day, remember second hand smoking is as bad as direct smoking; so tell your friends and family to stop smoking, ask your physician for any pharmacological support to maintain smoking cessation
6. Avoid alcohol intake.
7. Don't miss the drugs: some of the them are highly essential and even missing few doses matter a lot for drugs like anti-platelets, beta- blockers and angiotensin converting enzyme inhibitors (keep extra tablets of these with you all the time and if you miss them at your usual time, take them when you remember)
8. Reduce your weight, it is not only good for heart, it reduces blood pressure, improves blood sugars, reduces orthopedic problems
9. Have a good night sleep, recommended is between 6 and 9 hours
10. All of these activities may be difficult initially; take one step at a time, keep encouraging your peers to join with you.
11. In case you have chest pain take tab Aspirin 325 mg and tab Ticagrelor 90 mg two tablets stat along with PPI like Pantaprazole /Ranitidine. Typical pain is a chest pain in which pain is situated in the middle of the chest and it radiated to the arm along sweating if this type of pain occurs these tablets should be taken.If in doubt only aspirin 325 mg can be taken
Let's come together to make ourselves and the world with Happy and Healthy Heart. (LOVE YOUR HEART).
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