2024 SAEMF/GEMA Research Pilot Grant - $10,000

"Acute Coronary Syndrome in a Pakistan ED: Risk Factors and Clinical Pathway"

Non-communicable diseases are now a leading cause of morbidity and mortality across the world, particularly cardiovascular diseases, which cause approximately one-third of all deaths each year. Ischemic heart disease (IHD) and the emergency presentation of this disease process — acute coronary syndrome (ACS) — cause the majority of these deaths: more than 1.8 million deaths per year. Unfortunately, research focused on cardiovascular disease, and ACS in particular, is primarily focused in high-income countries (HIC), when the majority of the burden of most diseases is in low- and middle-income countries (LMIC). For example, in Pakistan, IHD results in at least 20 healthy life-years lost per 1000 people, and it has even been cited as the most common cause of death in certain areas of the country. Much of overall management of ACS is well-established, however there is ongoing work on risk identification and stratification of patients not presenting with the most acute presentation of ACS — ST-elevation myocardial infarction (STEMI) to the emergency department (ED). Current work in HIC is focused on determining risk of major cardiac events (MACE) for those not requiring emergency treatment via scores such as history, electrocardiogram, age, risk factors, and troponin (HEART) score, the Global Registry of Acute Coronary Events (GRACE) score, and thrombolysis in myocardial infarction (TIMI) in order to identify timing of further investigations and/or interventions, but, to date, little has been done to validate or expand on this work in LMIC. We aim to improve the identification and management of patients with possible ACS presenting to the ED in Karachi, Pakistan, through the identification of context-specific risk factors and the development of a care pathway.