Are Health-Related Tweets Evidence Based? Review and Analysis of Health-Related Tweets on Twitter.

BACKGROUND: Health care professionals are utilizing Twitter to communicate, develop disease surveillance systems, and mine health-related information. The immediate users of this health information is the general public, including patients. This necessitates the validation of health-related tweets by health care professionals to ensure they are evidence based and to avoid the use of noncredible information as a basis for critical decisions. OBJECTIVE: The aim of this study was to evaluate health-related tweets on Twitter for validity (evidence based) and to create awareness in the community regarding the importance of evidence-based health-related tweets. METHODS: All tweets containing health-related information in the Arabic language posted April 1-5, 2015, were mined from Twitter. The tweets were classified based on popularity, activity, interaction, and frequency to obtain 25 Twitter accounts (8 physician accounts, 10 nonofficial health institute accounts, 4 dietitian accounts, and 3 government institute accounts) and 625 tweets. These tweets were evaluated by 3 American Board-certified medical consultants and a score was generated (true/false) and interobserver agreement was calculated. RESULTS: A total of 625 health-related Arabic-language tweets were identified from 8 physician accounts, 10 nonofficial health institute accounts, 4 dietician accounts, and 3 government institute accounts. The reviewers labeled 320 (51.2%) tweets as false and 305 (48.8%) tweets as true. Comparative analysis of tweets by account type showed 60 of 75 (80%) tweets by government institutes, 124 of 201 (61.7%) tweets by physicians, and 42 of 101 (41.6%) tweets by dieticians were true. The interobserver agreement was moderate (range 0.78-0.22). More than half of the health-related tweets (169/248, 68.1%) from nonofficial health institutes and dietician accounts (59/101, 58.4%) were false. Tweets by the physicians were more likely to be rated "true" compared to other groups (P<.001). CONCLUSIONS: Approximately half of the medical tweets from professional accounts on Twitter were found to be false based on expert review. Furthermore, most of the evidence-based health-related tweets are posted by government institutes and physicians.

Polyvascular disease in patients presenting with acute coronary syndrome: its predictors and outcomes.

We evaluated prevalence and clinical outcome of polyvascular disease (PolyVD) in patients presenting with acute coronary syndrome (ACS). Data for 7689 consecutive ACS patients were collected from the 2nd Gulf Registry of Acute Coronary Events between October 2008 and June 2009. Patients were divided into 2 groups (ACS with versus without PolyVD). All-cause mortality was assessed at 1 and 12 months. Patients with PolyVD were older and more likely to have cardiovascular risk factors. On presentation, those patients were more likely to have atypical angina, high resting heart rate, high Killip class, and GRACE risk scoring. They were less likely to receive evidence-based therapies. Diabetes mellitus, renal failure, and hypertension were independent predictors for presence of PolyVD. PolyVD was associated with worse in-hospital outcomes (except for major bleedings) and all-cause mortality even after adjusting for baseline covariates. Great efforts should be directed toward primary and secondary preventive measures.

Measuring the health literacy level of Arabic speaking population in Saudi Arabia using translated health literacy instruments.

BACKGROUND: Health literacy is an essential predictor of health status, disease control and adherence to medications. OBJECTIVES: The study goals were to assess the health literacy level of the general population in Saudi Arabia using translated Gulf Arabic version of the short-version of the Test of Functional Health Literacy in Adults (S-TOFHLA) and Single Item Literacy Screener (SILS) tests and to measure the relationship between health literacy and education level. METHODS: The study was a cross-sectional with a convenience sample of 123 participants from the general population in Riyadh. Data were collected using the modified (Gulf) Arabic versions of both S-TOFHLA and SILS. Fisher's Exact test was used to measure the difference of the health literacy scores according to the education degrees and Cronbach's alpha was used to measure the internal consistency of the S-TOFHLA items. RESULTS: More than half (55.4%) of the participants were male, 50.4% had a middle school or less education level, and we found that 84.4% had adequate health literacy as measured by the S-TOFHLA, compared to 49.6% as measured by SILS. The Fisher's Exact test showed a significant difference (P<.05) in the S-TOFHLA and SILS scores according to education categories. CONCLUSIONS: The level of education has a significant positive association with S-TOFHLA and SILS results. The Gulf Arabic version of S-TOFHLA is a reliable test with a good internal consistency and a significant positive correlation between the two parts of S-TOFHLA. We recommend the use of S-TOFHLA or SILS at the first patient visit.

Impact of ramipril on the incidence of atrial fibrillation: results of the Heart Outcomes Prevention Evaluation study.

OBJECTIVES: We evaluated the effect of angiotensin-converting enzyme (ACE) inhibitor ramipril on the incidence of atrial fibrillation (AF) in patients enrolled in the Heart Outcomes Prevention Evaluation trial. BACKGROUND: Atrial fibrillation is the most common arrhythmia affecting the general population and is associated with increased morbidity and mortality. Retrospective secondary analyses of some of the large trials of ACE inhibitors have suggested that ACE inhibitors may prevent AF. METHODS: We evaluated the occurrence of AF by reviewing the electrocardiogram tracings at entry, at 2 years, and at the end of the study, as well as hospitalizations among 8335 high-risk participants from the Heart Outcomes Prevention Evaluation study, > or = 55 years, without known heart failure or left ventricular (LV) systolic dysfunction and followed for a median period of 4.5 years. We compared the impact of ramipril and matched placebo on occurrence of AF. The results were compared to similar trials. RESULTS: Over the 4.5 years follow-up, the incidence of new AF was low (2.1%, 177/8335), and ramipril did not significantly reduce the rate of new AF compared with placebo (86/4291 [2.0%] vs 91/4044 [2.2%]) with an odds ratio of 0.92 (95% confidence interval, 0.68-1.24; P = .57). These results added to the previous ACE inhibitor trials (excluding trials in patients with LV dysfunction) showed no significant reduction in new AF among patients treated with these agents (1088/20,930 [5.0%] vs 1343/22,878 [5.9%]; relative risk, 0.92; 95% confidence interval, 0.80-1.05). CONCLUSION: Although the incidence of AF was low, treatment with ramipril in this population without known LV systolic dysfunction did not significantly reduce this dysrhythmia.

The prevalence of cardiovascular diseases risk factors associated with psoriasis in Saudi Arabia.

BACKGROUND: Extensive studies have revealed an increased risk of major adverse cardiac outcomes in patients with severe psoriasis. However, some studies show conflicting results. OBJECTIVE: This study was conducted to assess the CV risk factors in psoriasis patients, and compare it with non-psoriatic patients. In addition, we evaluated if psoriasis is an independent CV risk factor, if its severity can predict CV risk, and if systemic psoriasis treatments modify CV risk. METHODS: This was a case-control study in 200 participants -100 with psoriasis, and 100 with dermatitis who served as the control. The study was carried out from September 2015 to September 2016. Data was collected using self-administered questionnaires, one each for both groups. Questions include body surface area, current psoriasis/dermatitis therapies, presence of diabetes mellitus, hypertension, smoking history, weight, height, body mass index (BMI), elevated cholesterol, Coronary Artery Disease (CAD) history. RESULTS: Analyses of the associations between psoriasis and CV symptoms has demonstrated that psoriasis was associated with CAD (p<0.001) and hospitalizations (p<0.001) due to CAD. We found that the psoriasis group have the following association: Angina (p=0.005), hypertension (p=0.001), diabetes mellitus (p=0.016), hypercholesterolemia (p=0.015), and "CAD succeeding psoriasis (p=0.001)" (it assesses how many patients with psoriasis had CAD after they are diagnosed with psoriasis). Our study showed that there was no statistically significant risk of CVD in dermatitis patients (p=0.16). There was no association between severity of psoriasis and CV risk (p=0.07). CONCLUSIONS: There is a higher CV risk prevalence among Saudi psoriatic patients and this confirms that psoriasis is an independent CV risk factor in this population.

Disparities in health care delivery and hospital outcomes between non-Saudis and Saudi nationals presenting with acute coronary syndromes in Saudi Arabia.

BACKGROUND: Saudi Arabia has a non-Saudi workers population. We investigated the differences and similarities of expatriate non-Saudi patients (NS) and Saudi nationals (SN) presenting with acute coronary syndromes (ACS) with respect to therapies and clinical outcomes. METHODS: The study evaluated 2031 of the 5055 ACS patients enrolled in the Saudi Project for Assessment of Acute Coronary Syndrome (SPACE) from 2005 to 2007. Propensity score matching and logistic regression analysis were performed to account for major imbalances in age and sex in the two groups. RESULTS: The mean patient age was 56.2±9.8, and 83.5% of the study cohort were male. SN were more likely to have risk factors of atherosclerosis. ST-elevation MI (STEMI) was the most common ACS presentation in NS, while non-ST ACS was more common in SN. The median symptom-to-door time was significantly greater in NS patients (Median 175 min (197) vs. 130 min (167), p=0.027). The only difference in pharmacological therapies between the two groups was that NS were more likely to receive fibrinolytic therapy. NS were less likely than SN to undergo percutaneous coronary interventions (PCI; 32.6% vs. 42.8%, p=0.0001) or primary PCI (7.8% vs. 22.8%, p<0.001). Hospital mortality, cardiogenic shock, and heart failure were significantly higher in NS compared to SN. After adjusting for baseline variables and therapies, the odds ratios for hospital mortality and cardiogenic shock in NS were 2.9 (95% CI 1.5-6.2, p=0.004) and 2.8 (95% CI 1.5-4.9, p<0.001), respectively. CONCLUSION: Our findings indicate disparities in hospital care between NS and SN ACS patients. NS patients had worse hospital outcomes, which may reflect unequal health coverage and access-to-care issues.

Absence of obesity paradox in Saudi patients admitted with acute coronary syndromes: insights from SPACE registry.

BACKGROUND AND OBJECTIVES: To describe the distribution of body mass index (BMI) and its relationship with clinical features, management, and in-hospital outcomes of patients admitted with acute coronary syndromes (ACS). DESIGN AND SETTINGS: The Saudi Project for Assessment of Coronary Events is a prospective registry. ACS patients admitted to 17 hospitals from December 2005-2007 were included in this study. METHODS: BMI was available for 3469 patients (68.6%) admitted with ACS and categorized into 4 groups: normal weight, overweight, obese, and morbidly obese. RESULTS: Of patients admitted with ACS, 72% were either overweight or obese. A high prevalence of diabetes (57%), hypertension (56.6%), dyslipidemia (42%), and smoking (32.4%) was reported. Increasing BMI was significantly associated with diabetes, hypertension, and hyperlipidemia. Overweight and obese patients were significantly younger than the normal-weight group (P=.006). However, normal-weight patients were more likely to be smokers and had 3-vessel coronary artery disease, worse left ventricular dysfunction, and ST elevation myocardial infarction. Glycoprotein IIb-IIIa antagonists were used significantly more in overweight, obese, and morbidly obese ACS patients than in normal-weight patients (P≤.001). Coronary angiography and percutaneous intervention were reported more in overweight and obese patients than in normal-weight patients (P≤.001). In-hospital outcomes were not significantly different among the BMI categories. CONCLUSION: High BMI is prevalent among Saudi patients with ACS. BMI was not an independent factor for in-hospital outcomes. In contrast with previous reports, high BMI was not associated with improved outcomes, indicating the absence of obesity paradox observed in other studies.

Clinical features, management, and short- and long-term outcomes of patients with acute decompensated heart failure: phase I results of the HEARTS database.

AIMS: The HEart function Assessment Registry Trial in Saudi Arabia (HEARTS) is a national multicentre project, studying clinical features, management, short- and long-term outcomes, and mortality predictors in patients admitted with acute decompensated heart failure (ADHF). METHODS AND RESULTS: Our prospective registry enrolled 2610 ADHF patients admitted to 18 hospitals in Saudi Arabia between October 2009 and December 2010, and followed mortality rates until January 2013. The patients included 66% men and 85.5% Saudis, with a median age (interquartile range) of 61.4 (15) years; 64% had acute on chronic heart failure (HF), 64.1% diabetes mellitus, 70.6% hypertension, and 55.7% CAD. Exacerbating factors for hospital admission included acute coronary syndromes (37.8%), infections (20.6%), non-compliance with low-salt diet (25.2%), and non-compliance with HF medications (20%). An LVEF<40% was found in 73%. In-hospital use of evidence-based medications was high. All-cause cumulative mortality rates at 30 days, 6 months, 1 year, 2 years, and 3 years were 8.3, 13.7, 19.5, 23.5, and 24.3%, respectively. Important independent predictors of mortality were history of stroke, acute on chronic HF, systolic blood pressure<90 mmHg upon presentation, estimated glomerular filtration rate<60 mL/min, and haemoglobin<10 g/dL. CONCLUSION: Patients with ADHF in Saudi Arabia presented at a younger age and had higher rates of CAD risk factors compared with those in developed countries. Most patients had reduced LV systolic function, mostly due to ischaemic aetiology, and had poor long-term prognosis. These findings indicate a need for nationwide primary prevention and HF disease management programmes.

Prevalence and prognosis of congestive heart failure in Saudi patients admitted with acute coronary syndrome (from SPACE registry).

OBJECTIVES: The aim of this study was to assess the prevalence, clinical features, and in-hospital outcomes of heart failure in patients with acute coronary syndrome (ACS). MATERIALS AND METHODS: The Saudi Project for Assessment of Coronary Events recruited patients admitted with ACS from 17 hospitals in Saudi Arabia from 2005 to 2007. The outcomes of ACS patients with congestive heart failure (CHF) compared with those without CHF were analyzed. RESULTS: A total of 4523 patients with ACS were identified, of whom 905 (20%) had CHF. Compared with no CHF, patients with CHF were older (62±13.1 vs. 57±12.9 years; P=0.001), less likely to be men (70 vs. 79%; P=0.001), likely to present with non-ST-segment elevation myocardial infarction (48 vs. 36%; P=0.001), likely to have diabetes (71 vs. 54%; P=0.001), hypertension (64 vs. 54%; P=0.001) and previous history of coronary artery disease (53 vs. 43%; P=0.001), and likely to have significant left ventricular systolic dysfunction (left ventricular ejection fraction <35%) (56 vs. 30%; P=0.001). Patients with CHF were less likely to receive in-hospital ß-blockers (74 vs. 86%; P=0.001) and a percutaneous coronary intervention (19 vs. 50%; P=0.001). Adjusted in-hospital mortality and cardiogenic shock were higher in the CHF group (odds ratio 4.43, 95% confidence interval 2.52-7.78; and odds ratio 3.51, 95% confidence interval 2.23-5.52), respectively. CONCLUSION: ACS patients with CHF in the Saudi Project for Assessment of Coronary Events were older, more likely to have more cardiac risk factors, and less likely to be treated with optimum medical treatment on admission. These findings were associated with higher incidence of their in-hospital adverse outcomes. More aggressive treatment is warranted to improve prognosis.

The prognostic impact of in-hospital worsening of renal function in patients with acute coronary syndrome.

BACKGROUND: Renal impairment is strongly linked to adverse cardiovascular (CV) events. Baseline renal dysfunction is a strong predictor of CV mortality and morbidity in patients admitted with acute coronary syndrome (ACS). However, the prognostic importance of worsening renal function (WRF) in these patients is not well characterized. METHODS: ACS patients enrolled in the SPACE (Saudi Project for Assessment of Coronary Events) registry who had baseline and pre-discharge serum creatinine data available were eligible for this study. WRF was defined as a 25% reduction from admission estimated glomerular filtration rate (eGFR) within 7 days of hospitalization. Baseline demographics, clinical presentation, therapies, and in-hospital outcomes were compared. RESULTS: Of the 3583 ACS patients, WRF occurred in 225 patients (6.3%), who were older, had more cardiovascular risk factors, were more likely to be female, have past vascular disease, and presented with more non-ST-segment elevation myocardial infarction than patients without WRF (39.5% vs. 32.8%; p=0.042). WRF was associated with an increased risk of in-hospital death, heart failure, cardiogenic shock, and stroke. After adjusting for potential confounders, WRF was an independent predictor of in-hospital death (adjusted odd ratio 28.02, 95% CI 13.2-60.28, p<0.0001). WRF was more predictive of mortality than baseline eGFR. CONCLUSION: These results indicate that WRF is a powerful predictor for in-hospital mortality and CV complications in ACS patients.

Measuring the health literacy level of Arabic speaking population in Saudi Arabia using translated health literacy instruments

Background: Health literacy is an essential predictor of health status, disease control and adherence to medications. Objectives: The study goals were to assess the health literacy level of the general population in Saudi Arabia using translated Gulf Arabic version of the short-version of the Test of Functional Health Literacy in Adults (S-TOFHLA) and Single Item Literacy Screener (SILS) tests and to measure the relationship between health literacy and education level. Methods: The study was a cross-sectional with a convenience sample of 123 participants from the general population in Riyadh. Data were collected using the modified (Gulf) Arabic versions of both S-TOFHLA and SILS. Fisher's Exact test was used to measure the difference of the health literacy scores according to the education degrees and Cronbach's alpha was used to measure the internal consistency of the S-TOFHLA items. Results: More than half (55.4%) of the participants were male, 50.4% had a middle school or less education level, and we found that 84.4% had adequate health literacy as measured by the S-TOFHLA, compared to 49.6% as measured by SILS. The Fisher's Exact test showed a significant difference (P<.05) in the S-TOFHLA and SILS scores according to education categories. Conclusions: The level of education has a significant positive association with S-TOFHLA and SILS results. The Gulf Arabic version of S-TOFHLA is a reliable test with a good internal consistency and a significant positive correlation between the two parts of S-TOFHLA. We recommend the use of S-TOFHLA or SILS at the first patient visit

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Impact of access to hospitals with catheterization facilities in the second Gulf Registry of Acute Coronary Events (Gulf RACE-2).

OBJECTIVES: It is currently unclear whether acute coronary syndrome patients who access hospitals with catheterization facilities, with or without an on-site percutaneous coronary intervention (PCI), have better outcomes in real-life clinical practice. METHODS AND RESULTS: This 9-month prospective study was carried out in six Arabian Gulf countries. Patients in hospitals with catheterization facilities [20/65 hospitals; 3615/6847 (52.8%) patients] were more likely to show evidence of cardiovascular risk factors (P<0.001) and more likely to undergo revascularization procedures that were mostly performed (≥80%) in low-risk and intermediate-risk patients. Patients in these centres experienced significantly higher rates of medical therapies and shorter door-to-needle times [median (IQR): 33 (40) vs. 43.5 (43) min, P<0.001]; 14.1% had primary PCI. They also had less in-hospital recurrent ischaemia, recurrent myocardial infarction, congestive heart failure and stroke, but more cardiogenic shock and major bleeding, and they had similar adjusted mortality rates in-hospital [odds ratio (OR): 1.06, 95% confidence interval (CI): 0.88-1.27] and at 30-day (OR: 1.11, 95% CI: 0.91-1.36) and 1-year (OR: 1.06, 95% CI: 0.89-1.27) follow-ups. CONCLUSION: Access to hospitals with catheterization facilities, with or without on-site PCI, was associated with a reduction in recurrent myocardial infarction and recurrent ischaemia, but not mortality. Further efforts are required to target revascularization procedures for higher risk patients as well as to widely implement primary PCI programmes.

Impact of diabetes on hospital adverse cardiovascular outcomes in acute coronary syndrome patients: Data from the Saudi project of acute coronary events.

BACKGROUND: Diabetes mellitus (DM) is a major public health problem in Saudi Arabia. DM patients who present with acute coronary syndrome (ACS) have worse cardiovascular outcomes. We characterized clinical features and hospital outcomes of diabetic patients with ACS in Saudi Arabia. METHODS: ACS patients enrolled in the Saudi Project for Assessment of Acute Coronary Syndrome (SPACE) study from December 2005 to December 2007, either with DM or newly diagnosed during hospitalization were eligible. Baseline demographics, clinical presentation, therapies, and in-hospital outcomes were compared with non-diabetic patients. RESULTS: Of the 5055 ACS patients enrolled in SPACE, 2929 (58.1%) had DM (mean age 60.2 ± 11.5, 71.6% male, and 87.6% Saudi nationals). Diabetic patients had higher risk-factor (e.g., hypertension, hyperlipidemia) prevalences and were more likely to present with non-ST-elevation myocardial infarction (40.2% vs. 31.4%, p < 0.001), heart failure (25.4% vs. 13.9%, p < 0.001), significant left ventricular systolic dysfunction and multi-vessel disease. Diabetic patients had higher in-hospital heart failure, cardiogenic shock, and re-infarction rates. Adjusted odds ratio for in-hospital mortality in diabetic patients was 1.83 (95% CI, 1.02-3.30, p = 0.042). CONCLUSIONS: A substantial proportion of Saudi patients presenting with ACS have DM and a significantly worse prognosis. These data highlight the importance of cardiovascular preventative interventions in the general population.

Glomerular filtration rate estimated by the CKD-EPI formula is a powerful predictor of in-hospital adverse clinical outcomes after an acute coronary syndrome.

The prognostic value of admission estimated glomerular filtration rate (eGFR) calculated by the new Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula for cardiovascular adverse outcomes in acute coronary syndrome (ACS) was explored. Baseline eGFR was classified as no renal dysfunction (>90 mL/min per 1.73 m(2)), borderline (90-60.1 mL/min per 1.73 m(2)), moderate (60-30.1 mL/min per 1.73 m(2)), or severe (≤30 mL/min per 1.73 m(2)) renal dysfunction. Of the 5034 patients, 3415 (67.8%) had eGFR <90. Compared to patients with an eGFR ≥60 mL/min per 1.73 m(2), patients with <60 mL/min per 1.73 m(2) were less likely to be treated with ß-blockers, angiotensin-converting enzyme inhibitors, or statins, or to undergo percutaneous coronary interventions. Lower eGFR showed a stepwise association with significantly worse adverse in-hospital outcomes. The adjusted odds ratio of in-hospital death with an eGFR <30 mL/min per 1.73 m(2) was 3.1 (95% confidence interval 1.1-8.4, P = .0324), compared with an eGFR >90 mL/min per 1.73 m(2). Estimated glomerular filtration rate calculated by the new CKD-EPI is an independent predictor of major adverse cardiac outcomes in patients with ACS.

Age and its relationship to acute coronary syndromes in the Saudi Project for Assessment of Coronary Events (SPACE) registry: The SPACE age study.

OBJECTIVE: To characterize risk profile of acute coronary syndrome (ACS) patients in different age groups and compare management provided to in-hospital outcome. DESIGN: Prospective multi-hospital registry. SETTING: Seventeen secondary and tertiary care hospitals in Saudi Arabia. PATIENTS: Five thousand and fifty-five patients with ACS. They were divided into four groups: ⩽40 years, 41-55 years, 56-70 years and ⩾70 years. MAIN OUTCOME MEASURES: prevalence, utilization and mortality. RESULTS: Ninety-four percent of patients <40 years compared to 68% of patients >70 years were men. Diabetes was present in 70% of patients aged 56-70 years. Smoking was present in 66% of those <40 years compared to 7% of patients >70 years. Fifty-three percent of the patients >70 years and 25% of those <40 years had history of ischemic heart disease. Sixty percent of patients <40 years presented with ST elevation myocardial infarction (STEMI) while non-ST elevation myocardial infarction was the presentation in 49% of patients >70 years. Thirty-four percent of patients >70 years compared to 10% of patients <40 years presented >12 h from symptom onset with STEMI. Fifty-four percent of patients >70 compared to 64-71% of those <70 years had coronary angiography. Twenty-four percent of patients >70 compared to 34-40% of those <70 years had percutaneous coronary intervention. Reperfusion shortfall for STEMI was 16-18% in patients >56 years compared to 11% in patients <40 years. Mortality was 7% in patients >70 years compared to 1.6-3% in patients <70 years. For all comparisons (p < 0.001). CONCLUSIONS: Young and old ACS patients have unique risk factors and present differently. Older patients have higher in-hospital mortality as they are treated less aggressively. There is an urgent need for a national prevention program as well as a systematic improvement in the care for patients with ACS including a system of care for STEMI patients. For older patients there is a need to identify medical as well as social factors that influence the therapeutic management plans.

Incidence of ventricular arrhythmia and associated patient outcomes in hospitalized acute coronary syndrome patients in Saudi Arabia: findings from the registry of the Saudi Project for Assessment of Acute Coronary Syndrome (SPACE).

BACKGROUND AND OBJECTIVES: Mortality in acute coronary syndrome (ACS) patients with ventricular arrhythmia (VA) has been shown to be higher than those without VA. However, there is a paucity of data on VA among ACS patients in the Middle Eastern countries. DESIGN AND SETTING: Prospective study of patients admitted in 17 government hospitals with ACS between December 2005 and December 2007. PATIENTS AND METHODS: Patients were categorized as having VA if they experienced either ventricular fibrillation (VF) or sustained ventricular tachycardia (VT) or both. RESULTS: Of 5055 patients with ACS enrolled in the SPACE registry, 168 (3.3%) were diagnosed with VA and 151 (98.8%) occurred in-hospital. The vast majority (74.4%) occurred in patients with ST-segment elevation myocardial infarction. In addition, males were twice as likely to develop VA than females (OR 1.7; 95% CI 1.13). Killip class >I (OR 2.0; 95% CI 1.3-3.1); and systolic blood pressure <90 mm Hg (OR 6.4; 95% CI 3.5-11.8) were positively associated with VA. Those admitted with hyperlipidemia (OR 0.49; 95% CI 0.3-0.7) had a lower risk of developing VA. Adverse in-hospital outcomes including re-myocardial infarction, cardiogenic shock, congestive heart failure, major bleeding, and stroke were higher for patients with VA (P≤.01 for all variables) and signified a poor prognosis. The in-hospital mortality rate was significantly higher in VA patients compared with non-VA patients (27% vs 2.2%; P=.001). CONCLUSIONS: In-hospital VA in Saudi patients with ACS was associated with remarkably high rates of adverse events and increased in-hospital mortality. Using a well-developed registry data with a large number of patients, our study documented for the first time the prevalence and risk factors of VA in unselected population of ACS.

Baseline characteristics, management practices, and long-term outcomes of Middle Eastern patients in the Second Gulf Registry of Acute Coronary Events (Gulf RACE-2).

BACKGROUND AND OBJECTIVES: Limited data are available on patients with acute coronary syndromes (ACS) and their long-term outcomes in the Arabian Gulf countries. We evaluated the clinical features, management, in-hospital, and long-term outcomes of in such a population. DESIGN AND SETTING: A 9-month prospective, multicenter study conducted in 65 hospitals from 6 countries that also included 30 day and 1-year mortality follow-up. PATIENTS AND METHODS: ACS patients included those with ST-elevation myocardial infarction (STEMI) and non-ST-elevation acute coronary syndrome (NSTEACS), including non-STEMI and unstable angina. The registry collected the data prospectively. RESULTS: Between October 2008 and June 2009, 7930 patients were enrolled. The mean age (standard deviation), 56 (17) years; 78.8% men; 71.2% Gulf citizens; 50.1% with central obesity; and 45.6% with STEMI. A history of diabetes mellitus was present in 39.5%, hypertension in 47.2%, and hyperlipidemia in 32.7%, and 35.7% were current smokers. The median time from symptom onset to hospital arrival for STEMI patients was 178 minutes (interquartile range, 210 minutes); 22.3% had primary percutaneous coronary intervention (PCI) and 65.7% thrombolytic therapy, with 34% receiving therapy within 30 minutes of arrival. Evidence-based medication rates upon hospital discharge were 68% to 95%. The in-hospital PCI was done in 21% and the coronary artery bypass graft surgery in 2.9%. The in-hospital mortality was 4.6%, at 30 days the mortality was 7.2% , and at 1 year after hospital discharge the mortality was 9.4% ; 1-year mortality was higher in STEMI (11.5%) than in NSTEACS patients (7.7%; P<.001). CONCLUSIONS: Compared to developed countries, ACS patients in Arabian Gulf countries present at a relatively young age and have higher rates of metabolic syndrome features. STEMI patients present late, and their acute management is poor. In-hospital evidence-based medication rates are high, but coronary revascularization procedures are low. Long-term mortality rates increased severalfold compared with in-hospital mortality.

Are acute coronary syndrome patients admitted during off-duty hours treated differently? An analysis of the Saudi Project for Assessment of Acute Coronary Syndrome (SPACE) study.

BACKGROUND AND OBJECTIVES: It is often suggested that acute coronary syndrome (ACS) patients admitted during off-duty hours (OH) have a worse clinical outcome than those admitted during regular working hours (RH). Our objective was to compare the management and hospital outcomes of ACS patients admitted during OH with those admitted during RH. DESIGN AND SETTING: Prospective observational study of ACS patients enrolled in the Saudi Project for Assessment of Acute Coronary Syndrome study from December 2005 to December 2007. PATIENTS AND METHODS: ACS patients with available date and admission times were included. RH were defined as weekdays, 8 AM-5 PM, and OH was defined as weekdays 5 PM-8 AM, weekends, during Eid (a period of several days marking the end of two major Islamic holidays), and national days. RESULTS: Of the 2825 patients qualifying for this analysis, 1016 (36%) were admitted during RH and 1809 (64%) during OH. OH patients were more likely to present with heart failure and ST elevation myocardial infarction (STEMI) and to receive fibrinolytic therapy, but were less likely to undergo primary percutaneous coronary interventions (PCI). The median door to balloon time was significantly longer (P<.01) in OH patients (122 min) than in RH patients. No differences were observed in hospital outcomes including mortality between the two groups, except for higher heart failure rates in OH patients (11.1% vs 7.2%, P<.001). CONCLUSIONS: STEMI patients admitted during OH were disadvantaged with respect to use and speed of delivery of primary PCI but not fibrinolytic therapy. Hospitals providing primary PCI during OH should aim to deliver it in a timely manner throughout the day.

Design and preliminary results of the heart function assessment registry trial in Saudi Arabia (HEARTS) in patients with acute and chronic heart failure.

AIMS: The heart function assessment registry trial in Saudi Arabia (HEARTS) is the first multicentre national quality improvement initiative in the Arab population to study the clinical features, management, and outcomes of inpatients admitted with acute heart failure (AHF) and outpatients with high-risk chronic heart failure (HCHF). METHODS AND RESULTS: We conducted a prospective pilot phase for the registry that included consecutive patients with AHF and HCHF in five tertiary care hospitals in Saudi Arabia between October 2009 and December 2010. The study enrolled 1090 patients, 722 (66.2%) of whom were admitted with AHF and 368 (33.8%) had HCHF. The mean age ± SD of AHF patients was 60.6 ± 15.3 years; 65.2% were men, 55.3% were de novo heart failure, 60.7% had diabetes mellitus, 72.5% had moderate or severe left ventricular (LV) systolic dysfunction, and 51.5% had coronary artery disease as the main aetiology. More than 80% of AHF and HCHF patients were treated with beta-blockers and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers. Patients with HCHF had a similar clinical profile, but only one-third had implantable cardioverter defibrillators. In-hospital mortality was 5.3% for AHF patients and 7.5% at 30 days after hospital discharge. CONCLUSION: Heart failure patients in Saudi Arabia present at a relatively younger age, have a much higher rate of diabetes mellitus, and predominantly have LV systolic dysfunction, which is mainly ischaemic in origin, compared with patients in developed countries. The preliminary results of the study show potential targets for improvement in care.

Baseline characteristics, management practices, and in-hospital outcomes of patients with acute coronary syndromes: Results of the Saudi project for assessment of coronary events (SPACE) registry.

OBJECTIVES: The Saudi Project for Assessment of Coronary Events (SPACE) registry is the first in Saudi Arabia to study the clinical features, management, and in-hospital outcomes of acute coronary syndrome (ACS) patients. METHODS: We conducted a prospective registry study in 17 hospitals in Saudi Arabia between December 2005 and December 2007. ACS patients included those with ST-elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction and unstable angina; both were reported collectively as NSTEACS (non-ST elevation acute coronary syndrome). RESULTS: 5055 patients were enrolled with mean age ± SD of 58 ± 12.9 years; 77.4% men, 82.4% Saudi nationals; 41.5% had STEMI, and 5.1% arrived at the hospital by ambulance. History of diabetes mellitus was present in 58.1%, hypertension in 55.3%, hyperlipidemia in 41.1%, and 32.8% were current smokers; all these were more common in NSTEACS patients, except for smoking (all P < 0.0001). In-hospital medications were: aspirin (97.7%), clopidogrel (83.7%), beta-blockers (81.6%), angiotensin converting enzyme inhibitors/angiotensin receptor blockers (75.1%), and statins (93.3%). Median time from symptom onset to hospital arrival for STEMI patients was 150 min (IQR: 223), 17.5% had primary percutaneous coronary intervention (PCI), 69.1% had thrombolytic therapy, and 14.8% received it at less than 30 min of hospital arrival. In-hospital outcomes included recurrent myocardial infarction (1.5%), recurrent ischemia (12.6%), cardiogenic shock (4.3%), stroke (0.9%), major bleeding (1.3%). In-hospital mortality was 3.0%. CONCLUSION: ACS patients in Saudi Arabia present at a younger age, have much higher prevalence of diabetes mellitus, less access to ambulance use, delayed treatment by thrombolytic therapy, and less primary PCI compared with patients in the developed countries. This is the first national ACS registry in our country and it demonstrated knowledge-care gaps that require further improvements.