World Doctors applauds PGIMER for decreasing Mortality in ACS
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Study finds a significant rise in the Survival of Chronic Heart syndrome cases

PGIMER did shock registry for the study

M4PNews|Chandigarh

As per PGIMER, Advanced Cardiac Centre Head claims, they have become World-leader in treating the severe condition of the heart and the World Cardiologists are looking up to them for this advancement. The cardiology department has been constantly trying to reduce the mortality rate in patients suffering from Acute Coronary Syndrome since 2001. As per Dr. Yash Paul, Head, after starting doing the shock registry and we found that the patients who used to have co-morbidity diseases like diabetes mellitus, hypertension, chronic kidney disease, septicemia, and advanced age, used to have mortality to the tune of 70-90%. In many countries, these patients were not included in the shock registry and research because these patients were not included in insurance reimbursement and there was a lack of evidence in treating these patients.

We tried 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 the pros and cons after taking all precautions and 360-degree approach. Consistently with our hard-working and sincere efforts, the mortality has progressively reduced drastically and survival rate increased to 70 percent. Our approach is to treat all patients including the sickest for real-world Registry of Acute Coronary Syndromes including patients with low socioeconomic status.

Dr. Yash Paul exerted that 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. Acute coronary syndrome mortality worldwide varies around 8% while in India it varies between 7 to 9%.

Initially, the mortality in the overall ACS population was around 16% till 2012 including Cardiogenic Shock, which has gradually reduced to current mortality between 6 to 7%. In the group of patients with cardiogenic shock, the mortality was 36% to 40% which has now been reduced to around 30% during 2018 – 2019. In patients with severe mitral regurgitation, the mortality was initially around 55% which has reduced to current mortality of around 40%.

In the overall ACS population

Acute coronary syndrome (ACS) Survivors (alive)Non- survivor (dead)
ACS, Jan 2011 to Aug 2012 (total 307 patients), Yash et. al., 307 (83.4%) 51 (16.6%)
 ACS, Jan 2018 to Dec 2018(total of 632 patients), Yash et. al., 589 (93.2%) 43 (6.8%)
ACS, Jan 2019 to Dec 2019(total of 571 patients), Yash et. al., 531 (93%) 40 (7%)
Gp 2b/3a inhibitors in ACS (intervention group), Yash et. al., 94 (94%) 6 (6%)

In cardiogenic shock population

Cardiogenic shock (CS) Survivors (alive) Non- survivors (dead)
CS, Jan 2011 to Aug 2012(total of 62 patients) Yash et. al., 40 (64.5%) 22 (35.5%)
CS (delayed presentation, IHJ), (total 147 patients) Yash et. al., 84(57.1%) 63 (42.9%)
CS, Jan 2018 to Dec 2018(total of 111 patients) Yash et. al., 78 (70.2%) 33 (29.8%)
CS, Jan 2019 to Dec 2019 (total of 104 patients) Yash et. al., 71 (69.3%) 33 (31.7%)

In patients with mechanical complications

Mechanical complicationsSurvivors Non- survivors
Ventricular septal rupture (Shock trial registry, Hochman et al) 7 (12.7%) 48 (87.3%)
Mitral regurgitation (shock trial registry, Hochman et al) 44 (45%) 98 (55%)
Mitral regurgitation, (Jan 2018 to Dec 2018 (total 88 patients) Yash et. al., 32 (58.2%) 23 (41.8%)
Mitral regurgitation (Jan 2019 to Dec 2019) Yash et. al., 16 (57.2%) 12 (42.8%)

These are the directions for keeping your heart healthy-

  1. Maintain regular activity, at least 150 minutes of weekly exercise of moderate-intensity (try to distribute over 5 days);
  2. Maintain stress-free environment, which you can do by meditation, activities like yoga will help in both ways, by reducing stress and by exercising your body; for stress “the less the better”
    • Reduce sugar intake (free sugars like sweets, soft drinks, other sweetened beverages)
    • Increase whole foods (fresh fruits, vegetables, whole grains)
    • Good quality high protein diet  (plant-based protein, If you are a non- vegetarian, can take non- frozen fish and non- red meat (poultry) products, egg white) / maintain normal Haemoglobin for better outcomes.
    • Avoid reusing oil multiple times and reduce overall oil usage
    • Reduce salt intake (reduces your blood pressure and heart failure symptoms)
  3. Reducing blood pressure will decrease the future occurrence of cardiovascular events; although different groups of patients will have different optimum levels of blood pressure (ask your physician for your optimum level)
  4. Control blood sugars, optimal is to maintain HbA1C around 7%  is also fine if you can’t maintain strict control of blood sugars.The low blood sugar level is more dangerous than mild high blood sugars.
  5. Absolutely avoid smoking, if you can’t stop completely start by reducing day by day, remember second-hand smoking is as bad as direct smoking; so tell your friends and family to stop smoking, ask your physician for any pharmacological support to maintain smoking cessation
  6. Avoid alcohol intake.
  7. Don’t miss the drugs: some of them are highly essential and even missing few doses matter a lot for drugs like anti-platelets, beta-blockers and angiotensin-converting enzyme inhibitors (keep extra tablets of these with you all the time and if you miss them at your usual time, take them when you remember)
  8. Reduce your weight, it is not only good for heart, but it also reduces blood pressure, improves blood sugars, reduces orthopedic problems
  9. Have a good night sleep, recommended is between 6 and 9 hours
  10. All of these activities may be difficult initially; take one step at a time, keep encouraging your peers to join with you.
  11. In case you have chest pain take tab Aspirin 325 mg and tab Ticagrelor 90 mg two tablets stat along with PPI like Pantaprazole /Ranitidine. Typical pain is a chest pain in which pain is situated in the middle of the chest and it radiated to the arm along with sweating if this type of pain occurs these tablets should be taken. If in doubt only aspirin 325 mg can be taken.

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