By Tricitynews
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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