dr. liberty o. yaneza - philippine college of physicians 2015.pdf · dr. liberty o. yaneza...

Dr. Liberty O. Yaneza

Immediate Past ChairPHA Council on Coronary Artery Disease

Epidemiology on Coronary Artery Disease (CAD- bara sa ugat sa puso”) Global: Cardiovascular diseases (CVDs) account for >17 million deaths globally each yearCAD: US: In 2010, CAD accounted for 48% of all deaths caused by CV disease & single most frequent cause of death WHO has estimated that by 2020 the global number of deaths from CAD will have risen from 7.6 million in 2005 11.1 million

Go AS, Mozaffarian D, Roger VL, et al: Heart disease and stroke statistics—2014 update: A report from the American Heart Association. Circulation 129:e28, 2014.American Heart Association: International Cardiovascular Disease Statistics. Dallas, American Heart Association, 2009

DOH top Morbidity 2010

DOH top Mortality 2010

What are the identifiable risk factors for coronary artery disease: 1.Hypertension2.Diabetes3.Older Age

1.45 y.o. male2.>55 y.o. female

4.Male5.High cholesterol6. obesity7.Physical Inactivity

***Lifestyle related factors

Philippine Data: National Nutrition & Health Survey (NNHeS)

2003, 2008 & NCR

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1998 2003 2008

Prevalence of Hypertension

Philippine Data : Prevalence of Diabetes: 1998, 2003 and 2008

High FBS level increased from 2003 to 2008 among Filipino adults.

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1998 2003 2008

Diabetes

Philippine Data : Comparison in the prevalence of dyslipidemia by total cholesterol, LDL-C, HDL-C and

triglyceride levels among adults

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2003 2008

TCLDLHDLTriglycerides

*TC >200; LDL >130; HDL <40; Triglycerides >400

From Dr. Dans and Dante Morales 2010: What have we learned?

1. Whatever we’re doing, is not adequately working.2. We need to do something new.3. Tx is too much, too late, too expensive.4. Education should be improved.5. We need to enable behavior change.6. Atherosclerosis is NOT a health problem, it’s a

disease of society.

To combat this foe..we must know more about the disease-PhilippinesWe need to determine how research-based evidence or guidelines applies to “real world” practice in the Philippines The Philippine Heart Association (PHA) *ACS Registry is a multicenter, prospective, observational registry of clinical management practices and patient outcomes in ACS.It is designed to collect analyze and disseminate data on ACS patients.main purpose of improving quality of care and reducing mortality

ACS: Acute Coronary Syndro

Short Background on

ACS registry PHA initiated activity started 2011 enrolled >2000 patientsParticipated by 14 hospitals with cardiology training program

Results: gender

Results: Age

Results: Management

Reasons:1. Financial Reasons2. Securing consent

Time Element Factors:

Symptom to Door Time: 14 hourssymptom to seeking consult

Door to Needle Time: 91 mins (107 mins)ER to administration of drug for heart attack (Ideal is 30 minutes)

Door to Balloon Time: 24 hrs (28 hrs)ER to cath lab (ideal is 90 minutes)

Summary• Lifestyle related factors such as

hypertension, smoking , and diabetes are highly prevalent in patients with ACS – Primary prevention is important

• Educate the public on Heart attack– What to do if suffering from chest pain

• Engage other agencies to assist in the treatment– Reimburse procedures such as coronary

angiogram and angioplasty and stent20