Research Project
9766433
ABSTRACT Although being a low-middle income country, Vietnam has been experiencing an epidemiologic transition to that of a developing country with an increasing prevalence of non-communicable diseases. According to the most recent national report, coronary heart disease (CHD) accounted for approximately 27,000 deaths among Vietnamese adults in 2010. No contemporary regional or national data are available describing the magnitude, impact, or how CHD is managed in Vietnamese men or women hospitalized with acute manifestations of CHD. Despite the considerable magnitude and impact of CHD in developed countries, there are extremely limited epidemiologic data available describing this increasing cause of morbidity, mortality, and loss of functional status in developing countries such as Vietnam, especially from the more generalizable perspective of a community-wide investigation and during recent years. We are proposing a pilot study to develop a population- based registry of residents from 2 provinces in northern and central Vietnam (Hai phong and Thanh hoa; total population: 1.8 and 3.4 million, respectively) hospitalized with acute myocardial infarction (AMI) at the 2 provincial medical centers in these areas during 2016. The overall aim of the proposed observational study is to describe the incidence rates of AMI, extent of patient's delay in seeking acute medical care, frequency of important in-hospital clinical complications, in-hospital and long-term survival rates and frequency of re- hospitalizations, and management practices used in the hospital treatment of AMI. The paper medical records of residents from these 2 areas hospitalized with a discharge diagnosis of AMI and related CHD diagnostic rubrics will be individually reviewed and validated by our trained research staff according to the updated Universal Redefinition of AMI. This schema classifies episodes of AMI into several types, the more frequent Type 1 MI (ST segment elevation AMI-STEMI or non-ST segment elevation AMI- NSTEMI) and less frequent Type 2 MI (demand ischemia). We anticipate identifying approximately 1,000 residents of these 2 provinces hospitalized with validated AMI in 2016. Information on patient's socio-demographic characteristics, medical history, clinical signs and symptoms, care seeking behavior, AMI associated characteristics, hospital therapies, clinical complications, and hospital and post-discharge survival and readmission status will be abstracted from hospital medical records for patients with Type 1 and Type 2 AMI. Eligible patients will be followed though the end of 2017 for purposes of identifying deaths as well as subsequent hospital and outpatient visits for cardiac and non-cardiac related reasons and their timing. Death certificates will be obtained at commune/district offices and carefully reviewed to record the date and cause of death for discharged patients as well as to identify out- of- hospital deaths due to CHD. Given the extremely limited data on CHD in this increasingly Westernized population, especially from the more generalizable perspective of a population-based investigation, and during a contemporary period, important insights would be provided into the clinical epidemiology of AMI, its management, and natural history to delineate points for more effective secondary prevention. This pilot study, which would be the first population-based surveillance project of CHD in Vietnam, represents a ground breaking endeavor that would provide data that would be used to create the necessary infrastructure for developing and eventually sustaining long-term surveillance of CHD in the Vietnamese population. This research will be carried out in Vietnam at the Hanoi University of Public Health in collaboration with Dr. Hoa Nguyen at Baylor Scott and White Health and Dr. Robert Goldberg from the University of Massachusetts Medical School. The companion NIH supported grant, Community Surveillance for Heart Disease (R01 HL 45434-26 and R56 HL45434) that the proposed study is modelled on, is a long-term population-based surveillance project of CHD among residents of the Worcester, MA, metropolitan area hospitalized at all central Massachusetts medical centers with independently validated AMI.
