TY - JOUR
T1 - Challenges and solutions in medically managed ACS in the Asia-Pacific region
T2 - Expert recommendations from the Asia-Pacific ACS Medical Management Working Group
AU - The Asia-Pacific ACS Medical Management Working Group
AU - Huo, Yong
AU - Thompson, Peter
AU - Buddhari, Wacin
AU - Ge, Junbo
AU - Harding, Scott
AU - Ramanathan, Letchuman
AU - Reyes, Eugenio
AU - Santoso, Anwar
AU - Tam, Li Wah
AU - Vijayaraghavan, Govindan
AU - Yeh, Hung I.
N1 - Funding Information:
The APAC ACS Medical Management Working Group project is funded by AstraZeneca , Shanghai, China.
Funding Information:
The authors disclose the following conflict of interest: WB has received fees for service from AstraZeneca, Daichii Sankyo, MSD, Novartis, Abbot Vascular, Medtronic and ST Jude Medical and is an advisory board member for AstraZeneca, Daichii Sankyo and Novartis; AS has received fees for service for participation at advisory boards for AstraZeneca, Merck-Sharp & Dome, Pfizer, Merck and Takeda; ER has received fees for service as member of advisory board from Servier, AstraZeneca, and E. Merck, and as speaker from Natrapharm, AstraZeneca, Servier, MSD, Novartis, and Merck; GV has nothing to disclose regarding any financial interests such as employment, stock ownership, paid expert testimony, as well as any personal relationships, academic competition, and intellectual passion which may inappropriately influence his actions in the preparation of this manuscript; H-IY has received fees for service for participation as a speaker at AstraZeneca, Bayer, Boehringer Ingelheim, Daiichi Sankyo, Merck-Sharp & Dome, Pfizer, Sanofi, Servier, Takeda and Tanabe-sponsored symposia; LR has received fees for service as speaker for AstraZeneca, Servier, Novartis, Novo, Merck-Sharp & Dome and Abbott Pharmaceuticals. SH has acted in an advisory capacity for AstraZeneca, Sanofi Aventis and Eli Lilly, has received fees for service for speaking from Eli Lilly and AstraZeneca, and has received a research grant from AstraZeneca; PT has received consulting fees and speakers fees for Astra Zeneca, Bayer, Boehringer Ingelheim, Bristol Myers Squibb and Pfizer. LWT, JG and HY have nothing to disclose regarding any financial interests such as employment, stock ownership, paid expert testimony, or personal relationships, academic competition, or intellectual passion that may have inappropriately influenced their actions in the preparation of this manuscript.
Funding Information:
The meeting on which this report was based was supported by AstraZeneca. All authors received fees for service to support attendance at the meeting and preparation of meeting materials. All authors were provided with travel and hotel costs to attend the meeting.
Funding Information:
Melanie Jones (Prime Medica Ltd, Knutsford, Cheshire, UK) provided medical writing support during the manuscript development, funded by AstraZeneca. Responsibility for opinions, conclusions and interpretation of the data lies with the authors. Employees of AstraZeneca were permitted to read the first draft and final draft of the manuscript and make suggestions on scientific and technical accuracy only. It was the authors' decision whether to accept or reject any suggestions made by AstraZeneca. Responsibility for opinions, conclusions and interpretation of the data lies with the authors.
Publisher Copyright:
© 2014 Elsevier Ireland Ltd. All rights reserved.
PY - 2015/3/15
Y1 - 2015/3/15
N2 - Abstract Acute coronary syndromes (ACS) remain a leading cause of mortality and morbidity in the Asia-Pacific (APAC) region. International guidelines advocate invasive procedures in all but low-risk ACS patients; however, a high proportion of ACS patients in the APAC region receive solely medical management due to a combination of unique geographical, socioeconomic, and population-specific barriers. The APAC ACS Medical Management Working Group recently convened to discuss the ACS medical management landscape in the APAC region. Local and international ACS guidelines and the global and APAC clinical evidence-base for medical management of ACS were reviewed. Challenges in the provision of optimal care for these patients were identified and broadly categorized into issues related to (1) accessibility/systems of care, (2) risk stratification, (3) education, (4) optimization of pharmacotherapy, and (5) cost/affordability. While ACS guidelines clearly represent a valuable standard of care, the group concluded that these challenges can be best met by establishing cardiac networks and individual hospital models/clinical pathways taking into account local risk factors (including socioeconomic status), affordability and availability of pharmacotherapies/invasive facilities, and the nature of local healthcare systems. Potential solutions central to the optimization of ACS medical management in the APAC region are outlined with specific recommendations.
AB - Abstract Acute coronary syndromes (ACS) remain a leading cause of mortality and morbidity in the Asia-Pacific (APAC) region. International guidelines advocate invasive procedures in all but low-risk ACS patients; however, a high proportion of ACS patients in the APAC region receive solely medical management due to a combination of unique geographical, socioeconomic, and population-specific barriers. The APAC ACS Medical Management Working Group recently convened to discuss the ACS medical management landscape in the APAC region. Local and international ACS guidelines and the global and APAC clinical evidence-base for medical management of ACS were reviewed. Challenges in the provision of optimal care for these patients were identified and broadly categorized into issues related to (1) accessibility/systems of care, (2) risk stratification, (3) education, (4) optimization of pharmacotherapy, and (5) cost/affordability. While ACS guidelines clearly represent a valuable standard of care, the group concluded that these challenges can be best met by establishing cardiac networks and individual hospital models/clinical pathways taking into account local risk factors (including socioeconomic status), affordability and availability of pharmacotherapies/invasive facilities, and the nature of local healthcare systems. Potential solutions central to the optimization of ACS medical management in the APAC region are outlined with specific recommendations.
KW - Acute coronary syndromes
KW - Asia-Pacific
KW - Conservative
KW - Medical management
KW - Myocardial infarction
UR - http://www.scopus.com/inward/record.url?scp=84926635955&partnerID=8YFLogxK
U2 - 10.1016/j.ijcard.2014.11.195
DO - 10.1016/j.ijcard.2014.11.195
M3 - Review article
C2 - 25662044
AN - SCOPUS:84926635955
VL - 183
SP - 63
EP - 75
JO - International Journal of Cardiology
JF - International Journal of Cardiology
SN - 0167-5273
M1 - 19352
ER -