Y.S. RANA :
CHANDIGARH—Advanced Cardiology Centre of the PGI, Chandigarh has achieved success in reducing the mortality of heart patients through better treatment, stated by Dr. Yashpal Sharma, Head of Cardiology Department. He further revealed that India has less mortality rate due to heart problems compared to the world and PGI has been at the top.
Dr. Sharma said that the Centre has started efforts to reduce the death rate of acute coronary syndrome patients in 2001 and achieved success. Initially, it was started in patients with cardiogenic shock with all comorbid diseases like diabetes mellitus, hypertension, chronic kidney disease, septicemia, and advanced age, who used to be very sick and have mortality to the tune of 70-90%. In many countries, these patients were not included in insurance reimbursement and there was a lack of evidence in treating such patients.
From 2003 onwards we have presented our data and evidence in medical literature nation and international conferences and many lectures inside our institute. Planned research with ethical clearance was started from 2007 onwards to see the trend of Cardiogenic Shock and Acute Coronary Syndromes, says Dr. Sharma.
Acute coronary syndrome mortality worldwide varies around 8% while in India it varies between 7 to 9 percent. Initially, the mortality in the overall ACS population was around 16 percent including Cardiogenic Shock, which has gradually reduced to current mortality between 6 to 7 percent. In the group of patients with cardiogenic shock, the mortality was 36 percent to 40 percent which has now been reduced to around 30 percent during 2018 – 2019. In patients with severe mitral regurgitation, the mortality was initially around 55 percent which has reduced to current mortality of around 40 percent.
“We try to intervene in such patients with a strategic and integrated approach, sometimes when the intervention is highly risky and complicated by getting informed high-risk consent by explaining pros and cons after taking all precautions and 360-degree approach. Consistently with our hard-working and sincere efforts the mortality has progressively reduced. Our approach is to treat all patients including the sickest for real-world Registry of Acute Coronary Syndromes including patients with low socioeconomic status”, said Dr. Sharma.
There is a lack of data regarding patients presenting late after symptom onset (_12 h) with ST-elevation myocardial infarction and complicated by cardiogenic shock (CS-STEMI), and the optimal treatment strategies in these patients remain poorly defined. Given a large number of patients in low- and middle-income countries with this profile, it is important to determine the optimum management strategy to improve their outcomes, asserts Dr. Sharma.
The department was visited by various faculty including Prof C. Thomas Peter from Cedars- Sinai medical center, California one of the top Cardiology Institutes in the world and other faculty from Mayo clinic and reputed hospitals, they were impressed by our approach to the patient care and by our patient outcomes and they have even started following our methods of treatment in their hospitals.
Aim at achieving lower mortality world-wide by using a well-monitored, innovative and integrated approach in high-risk cohorts of acute coronary syndromes using cost-effective approaches. For this, they have already started a multi-centric national Registry for patients with acute coronary syndrome and Cardiogenic shock. Through this Registry, they will be sharing their experience and guiding other centers across India to achieve lower mortality along with low cost in patients with acute coronary syndrome, stated he.