Outcomes and Quality of Recovery at One Year Following Percutaneous Coronary Intervention for ST Elevation Myocardial Infarction in Sri Lanka
Ranasinghe WG., Beane A., Priyadarshani GDD., Vithanage TDP., Colombage DDE., Rajakanthan K., Rajapakse S., Ponnamperuma CJ., Karunarathne S., Silva APD., Sovis WFRD., Sajeev S., Jayasinghe VP., Schultsz C., Dondorp AM., Haniffa R.
Abstract Background . Long term quality of recovery following percutaneous coronary intervention in Sri Lanka are unknown. We evaluated quality of recovery at one year, compliance with secondary prevention medications and access to and uptake of cardiac rehabilitation services. Methods . The GRACE Risk Model was used to compare predicted and actual mortality at hospital discharge and at one-year. Quality of recovery was assessed by the Seattle Angina Questionnaire. Compliance with secondary prevention therapy was assessed using international guidelines. Access to cardiac rehabilitation was assessed via telephone- administered interview. Results . Between April 2017 and March 2018, 699 consecutive patients underwent percutaneous coronary intervention. Mortality at one year was 13.6% (93); predicted mortality was (4.5–11%). Functional activity was significantly worse at one year 64.4 (75.6–55.6) compared to pre-admission (100, 100 − 84.4) (P-value < 0.01). Frequency of angina was greater at one year (80, IQR = 100 − 60), compared with 1-month post-discharge (100[IQR = 100 − 80], P-value < 0.01). Stability of angina remained unchanged (median[IQR] = 72[100 − 50]). Patients’ perceptions of treatment satisfaction were high (P-value < 0.01), disease perceptions worsened (P-value < 0.01). Self-perceived compliance with secondary prevention therapy ranged from 75%-82%. Of the 362 patients followed up 146 (44.5%) reported being offered the opportunity to attend cardiac rehabilitation; 128 (87.7%) attended. Conclusions . Outcomes at one year were poorer than expected. Patient-reported levels of satisfaction were high, despite worsening burden of symptoms. Research is needed to better understand patients' expectations of quality of acute myocardial infarction care.