Abstract:
Acute coronary syndrome the is the leading cause of cardiovascular mortality
worldwide. Studies show that the burden, in-hospital mortality and adverse treatment
outcomes of the disease is increasingly becoming common in developing Sub-Saharan
countries, including Ethiopia due to different factors. Despite this, data regarding the
treatment outcome of acute coronary syndrome and associated factors is lacking in public
hospitals of Harari region, Eastern Ethiopia. Besides, few previous studies on acute coronary
syndrome are available in the country are focused on mortality and clinical/management
outcomes.
Objectives: The study aimed to assess the treatment outcome and associated factors of acute
coronary syndrome (ACS) among patients admitted to Public Hospitals of Harari Region,
Eastern Ethiopia, from November 1, 2018 to October 31, 2023.
Methods: A hospital based cross-sectional study was conducted on 308 ACS patients
admitted to public hospitals of Harari region from November 1, 2018 to October 31, 2023.
Chart review was conducted and checklist was used to obtain critical demographic data and
associated factors by the data collection team from charts of patients. Data were entered and
analyzed using SPSS version 25.0. Descriptive statistics were used to describe the
characteristics of the sample and determine treatment outcome of ACS patients. Bivariable
and multivariable binary logistic regression analyses were used to identify factors
significantly associated with treatment outcome of acute coronary syndrome patients.
Adjusted odds ratio (AOR) (95% CI) was used to report the adjusted association and
statistical significance was declared at P-value<0.05.
Results: Of 308(100.0%) ACS patients, who were admitted during the 5 years period, 201
(65.3%) were diagnosed with STEMI. The mean age ± SD of the patients was 56.41 ± 16.029
years, and 238(77.3%) of the participants were males. Commonest presenting symptoms
were chest pain, 190(61.7%) and shortness of breath, 149(48.4%). 111(36.0%) of the
patients presented after 72 hours of symptom onset, and the mean time to presentation ± SD
was 66.28 ± 46.25 hours. Mean SBP ± SD was 123.43 ± 26.307 mmHg. Hypertension,
133(43.2%), diabetes mellitus, 112(36.4%), and history of smoking, 208(67.5%), were the
commonest risk factors identified in patients with ACS. Echocardiographic features of
ischemia were seen in 117(54.2%) patients. 19.2% of the patients had LVEF <40%, and
9.1% had LVEF <30%. Loading doses of aspirin and clopidogrel were given in 95.5% and
93.8% of patients respectively. Heparin (92.9%), beta blocker (83.8%), ACEI/ARB (84.7%),
morphine (86.0%), and statin (92.2%) were the most commonly given medications. The
mean ± SD hospital stay of the patients was 8.34± 3.67 days. Among the total enrolled ACS
patients, 81(26.3%) had poor outcome (died, referred to other facilities or left against
medical advice). Presentation to hospital 72 hours after symptom onset [AOR=2.734(1.006,
7.435)], left ventricular ejection fraction <30% [AOR=5.317(1.085, 26.058)], and presence
of ischemic features on echocardiography [AOR=3.350(1.438, 7.801)], were independent
predictors of poor treatment outcome.
Conclusion: The overall outcome of patients with ACS in our study is poor. Early and better
management practices, addressing risk factors, and creating awareness to the society should be
implemented to improve the treatment outcome.