The quality of care in acute coronary syndrome and its association with mortality in the united arab emirates: Data from the gulf race

Aim. Objective of the present study was to evaluate the quality of care and outcome in patients with acute coronary syndrome (ACS) according to international guidelines.

Methods. We used data from the Gulf Registry of Acute Coronary Events (Gulf RACE). A sub sample of 1693 patients from the United Arab Emirates (UAE) was analyzed.

Results. In all ACS patients, aspirin and statins were adequately prescribed on admission and at discharge, whereas, the treatment with an- giotensin-converting enzyme inhibitor (ACEI)/ angiotensin II receptor blocker (ARIIB), clopi- dogrel, and beta-blockers (BB), increased at discharge according to guideline-recommend- ed treatment. The use of clopidogrel and BB at discharge was significantly different in the three ACS classes. Patients who were receiving all five guideline-recommended drugs, were mainly males (P=0.0001) and more in the age groups of (< 55 and 55-74 years). Smokers were better treated than non-smokers, but patients with prior coronary artery disease (CAD) did not receive optimal treatment. Mortality was significantly (P=0.0001) less among the subjects who received adequate treatment (0.1%) than those who did not (4.3%). Multivariate regression analysis, showed that age [adjusted OR: 1.051; 95% CI: 1.015-1.089; P=0.0051 and the use of all five guideline-rec- ommend drugs [adjusted OR: 0.042; 95% CI: 0.005-0.319; P=0.002 (protective effect)! were independent predictors of death.

Conclusion. The quality of care for patients with ACS in the UAE seems to be modest and the use of guideline-recommended drugs is suboptimal. The need for improved care, particularly, among elder patients, and adherence to guideline-recommended treatment is highlighted.