Health Care Assessment of Patients with Acute Coronary Syndrome in Sung Noen Hospital, Changwat Nakhon Ratchasima, 2007

Abstract

       The purpose of this retrospective study was to assess health care of patients with Acute Coronary Syndrome (ACS). Twenty patients with cardiovascular chest pain at emergency room in Sung Noen Hospital were assessed by “Clinical Practice Guidelines of chest pain” (CPG chest pain) and “chest pain pathway” of Sung Noen Hospital from January to June, 2007. It was found that acute coronary syndrome and acute ST Elevate Myocardial Infarction (STEMI) diagnosed in 90 and 60 per cent of patients with chest pain respectively. Most of acute coronary syndrome patients were male (55.6%). Smoking risk factor accounted for 71.4 percent of those males with acute coronary syndromes. Eighty percent of the patients with chest pain were primarily managed in line with clinical practice guidelines of chest pain, but only 40 percent underwent electrocardiogram (ECG) within 10 minutes as planned. Ninety percent of these patients were referred to Maharat Nakhon Ratchasima Hospital, but 11.1 percent made it as specified. Patients with previous chest pain but undiagnosed as cardiovascular chest pain were found in 27.8 percent of the patients with acute coronary syndrome. Treatment for these patients were, hence, delayed and some died before being referred to Maharat Nakhon Ratchasima Hospital. Only 33.3 percent of the patients with acute STEMI were treated by reperfusion therapy. Fatalities in patients with acute coronary syndrome and acute STEMI were 27.8 and 16.7 percent respectively. It was proposed that patients with risk factors for acute coronary syndrome should be screened by electrocardiogram in spite of inconspicuous cardiovascular chest pain. Revision of clinical practice guidelines of chest pain, improvement of electrocardiogram interpretation competency of registered nurses and patients’ home health care should be further assessed and improved for patients with acute coronary syndrome.

Key words: acute coronary syndrome (ACS), health care assessment, community hospital