The importance of networking for the management of acute coronary syndrome (ACS) has been emphasised in the 2012 guidelines by the European Society of Cardiology (ESC) on ST-segment elevation myocardial infarction (STEMI). In Penang, the ACS referral network has the Penang General Hospital (PGH), a percutaneous coronary intervention (PCI)- capable hospital, with 14 other hospitals referring their patients for PCI to PGH on a daily basis. In one of its review regarding the referral methodology in the network, PGH's Cardiology centre observed gaps in the referral systems, which was leading to poor quality of referrals. To address these issues, the PGH Cardiology centre developed a standardised protocol and conducted a one-day workshop to educate medical officers about the standardised protocol. This commentary piece is a proof of this concept, and aims to share the experience and provide an overview on the initiatives by the PGH, which has resulted in improved quality of PCI referrals.
One hundred consecutive patients attending the UKM (Universiti Kebangsaan Malaysia) Cardiology Clinic completed a questionnaire enquiring about their own assessment of their knowledge about their illness, their awareness of cardiac risk factors and their expectations in their management. Only 11% of our patients had graduated from tertiary education. 59% of our patients were being treated for ischaemic heart disease. Although only 28% of our patients considered having considerable knowledge of their illness, a majority of our patients were aware of cardiac risk factors. This was independent of the formal education achieved. However this awareness did not necessarily result in appropriate behaviour; 32% of patients admitted to smoking despite being aware of the harmful effects of smoking. 74% of our patients expected a cure from their doctors; only 37% of our patients thought they required medication indefinitely. Thus, patients could be made aware of their illness regardless of their formal educational status. However this may not necessarily result in appropriate behaviour. The high expectations which the patients have of their doctors is unrealistic and may be detrimental to appropriate long-term management of their chronic illness.
Study site: Cardiology Clinic, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM)
Three hundred thirty-one consecutive patients presenting with hypertension to the outpatient medical clinic of Tengku Ampuan Afzan Hospital, Kuantan, Malaysia were screened and 150 patients with concurrent diabetes were enrolled into a cross-sectional study. The majority of patients were male (60.6%) with a mean age of 60.0 +/- 11.0 years. The mean systolic blood pressure (SBP) was 140.9 +/- 20.1 mmHg and the mean diastolic blood pressure (DBP) was 81.7 +/- 9.8 mmHg. Only 38.0% (57/150) of patients had blood pressures within recommended guidelines (130/80 mmHg). The mean blood pressure in this group was 123.7 +/- 8.5/76.4 +/- 5.6 mmHg. The majority of patients were on either 2 (41.3%) or 3 (31.3%) anti-hypertensives. Females had a significantly higher SBP 145.4 +/- 22.7 vs. 138.0 +/- 17.8 mmHg in males (p = 0.026). The level of blood pressure control in diabetics was unsatisfactory, especially in females and the elderly. A reassessment of priorities in the management of patients with concurrent hypertension and diabetes is therefore, urgently needed.
Study site: outpatient medical clinic of Tengku Ampuan Afzan Hospital,