Integrating coronary artery calcium scores into primary prevention for acute coronary syndrome in patients with noncommunicable disease: A system development approach in Phetchabun Hospital
Keywords:
acute coronary syndrome, coronary artery calcium score, primary preventionAbstract
Background: Acute coronary syndrome (ACS) is a major public health issue and a leading cause of death in Thailand. Primary prevention, holistic management, and secondary prevention play vital roles in its management. Objective: This study aimed to identify systemic issues in ACS primary prevention in Phetchabun Hospital and examine the impact of a new holistic, multidisciplinary paradigm approach for ACS primary prevention. Methods: This research and development study included patients being treated for noncommunicable disease (NCD) at Phetchabun Hospital. The patients’ coronary artery calcium scores (CACSs) were compared between the ACS and non-ACS groups. Treatment outcomes before and after the implementation of the holistic integration approach were also compared. Results: Of the 171 patients with NCD, 55% were treated with an inappropriate level of statins (75.3% undertreated and the rest overtreated) based on their 10-year atherosclerotic cardiovascular disease risk score. The average CACS was significantly higher in the ACS group (417.50; interquartile range [IQR]: 147.25–688.27) than in the non-ACS group (0; IQR: 0–27.90, p < 0.001). In addition, the holistic approach significantly reduced total cholesterol (200.16 ± 53.22 vs. 148.26 ± 38.53, p < 0.001), low-density lipoprotein cholesterol (127.48 ± 43.28 vs. 77.70 ± 32.24, p < 0.001), fasting blood glucose (130.38 ± 56.48 vs. 115.78 ± 50.45, p = 0.022), and body weight (67.12 ± 12.60 vs. 66.03 ± 11.73, p = 0.01). Conclusion: Over half of the patients with NCD received suboptimal management. CACS effectively helped distinguish ACS from non-ACS cases. A multidisciplinary, holistic approach significantly improved primary prevention outcomes for patients with NCD.
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