Adherence to guideline mandated optimal medical therapy for acute coronary syndrome at Charlotte Maxeke Johannesburg Academic Hospital

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dc.contributor.authorMtwesi, Viwe
dc.date.accessioned2021-10-13T12:16:09Z
dc.date.available2021-10-13T12:16:09Z
dc.date.issued2020
dc.descriptionA dissertation submitted in partial fulfilment of the requirements for the degree of Master of Medicine (MMed) in the division of Internal Medicine to the Wits Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, 2020en_ZA
dc.description.abstractABSTRACT Acute coronary syndrome (ACS) is the leading cause of death worldwide. Optimal medical therapy significantly reduces mortality resulting from ACS. Adherence to guideline medical mandatory therapy has been demonstrated to be suboptimal in most parts of the world, especially in developing countries. The current study assesses the effects of adhering to guideline mandatory therapy on the outcome in patients presenting with ACS. METHODS This is a retrospective record review of 1073 patients, who presented with ACS, admitted to the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), from January 2013 to December 2014. Patients were over the age of 18. Records were retrieved from an existing database in the Cardiology Department. The use of commonly used prescribed medication was assessed, which included aspirin, statins, beta blockers, clopidogrel, ACE inhibitors, and spironolactone.RESULTS The majority of the patients were male (73.3%). The racial demographics of the patients were as follows: 46% were White, 22.8% were Indian, 19.8% were Black, and 10.3% were Coloured. STEMI was the most common presentation (52%), followed by unstable angina (30%), and NSTEMI (18%). Aspirin was the most prescribed drug at 85%, followed by statins, beta blockers, clopidogrel, ACE inhibitors, and spironolactone at 84%, 79%, 74%, 54% and 38% respectively. Creatinine levels were indirectly associated with the prescription of ACE inhibitors and clopidogrel. Age and gender were also found to influence drug prescription. The survival rates for the CMJAH admitted ACS patients on optimal medical therapy were high, at 96%, which was statistically significantly. Upon discharge, there was a 4% in-hospital mortality rate from ACS. CONCLUSION ACS presents most commonly as STEMI. Almost three-quarters of the ACS patients were males. There was a strong correlation between the use of guideline mandated therapy and reduced mortality rates. The findings of this study reinforce the need for proper diagnosis and appropriate medical treatment to improve the life expectancy of ACS patients.en_ZA
dc.description.librarianTL (2021)en_ZA
dc.facultyFaculty of Health Sciencesen_ZA
dc.identifier.urihttps://hdl.handle.net/10539/31697
dc.language.isoenen_ZA
dc.titleAdherence to guideline mandated optimal medical therapy for acute coronary syndrome at Charlotte Maxeke Johannesburg Academic Hospitalen_ZA
dc.typeThesisen_ZA
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