TREATMENT OUTCOME OF ACUTE CORONARY SYNDROME AND ASSOCIATED FACTORS AMONG PATIENTS ADMITTED TO PUBLIC HOSPITALS IN HARARI REGION, EASTERN ETHIOPIA RESEARCH THESIS

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.