A Prospective Study of Practice Pattern and Outcomes in Acute Myocardial Infarction and Unstable Angina in Various Regions of Nepal

Abstract

Background: Ischaemic heart disease is one of the leading causes of mortality and morbidity in the world. The burden of this disease in Nepal and India is huge. With large burden of ischaemic heart disease in Nepal, a study of practice pattern and analysis of its appropriateness will therefore, now, be timely and important. Methods: This was a multi-centric prospective observational study with two centers in Kathmandu valley. 122 patients at National Academy of Medical Sciences, Bir Hospital and 22 patients at Medicare National Hospital and Research Center were studied for a period of nine months (July 2003 to March 2004). Data was collected by means of a simple case report form Results: Ischaemic heart disease event in male patients was 1.8 times more than female. Myocardial infarction was common than unstable angina. Most common risk factor was smoking (74%). Hypertension was present in 43% and diabetes mellitus in 27%. Thrombolysis was done in 22% only while myocardial infarction was present in 56% of patients. Only 11% of patients were taking Aspirin before hospital admission. During hospital stay, 98.6% of patients received Aspirin. Before admission, drugs taken by patients were nitrate in 9.64%, ACEI in 13.38%, B-blockers in 14.08%, CC blockers in 10.56% and statins in 4.93% only. In hospital, nitrate was given to 98.61%, ACEI in 83.10%, B-blocker in 79.58%, CC blocker in 6.34% and statins in 86.62%. 6.34% of patients received anti arrhythmic therapy during hospital stay. In hospital mortality was 7% and death occurred within 30 days was 3.5%. Conclusions: Male predominance was seen in ischaemic heart disease events. Underutilization of drugs like aspirin, B-blocker, statins, ACEI was seen in these patients. Keywords: ischaemic heart disease; myocardial infarction; Nepal; regions; unstable angina.