Several population based cross-sectional studies in India have shown a rising trend in the prevalence of coronary artery disease (CAD) in urban India. According to the April issue of the Indian Journal of Medical Research (IJMR), the inter heart study, mentioned in the journal, in 52 countries observed high prevalence of CAD risk factors like diabetes, hypertension, smoking, dyslipidaemia and obesity in Indian population that leads to ACS like heart attack.

“Though several population based cross sectional studies in India have shown a rising trend in the prevalence of coronary artery disease (CAD), very few studies have looked at the spectrum of acute coronary syndromes (ACS), viz. unstable angina, non ST-segment elevation myocardial infarction (NSTEMI) and ST segment elevation myocardial infarction (STEMI). Well conducted acute coronary event (ACE) registries are known to provide data that can be used to improve allocation of health resources,” said Dr Bela Shah senior scientist at ICMR.

Indian Council of Medical Research is therefore planning to initiate hospital based acute coronary event (ACE) registries which will be collecting information on hospital admissions including Indian patient characteristics, types of events, treatment, status at discharge and outcome after different time intervals of the acute event.

Early this year health minister Anbumani Ramadoss at the launch of the pilot phase of the national programme for prevention and control of diabetes, cardio-vascular diseases and stroke, said “the non-communicable diseases (NCDs), especially cardiovascular diseases (CVD’s), diabetes mellitus, cancer, stroke and chronic lung diseases have emerged as major public health problem.

The project that is in the preparation mode will be in phases. “In the first phase of the project, registries will be initiated at sites. Selection of sites will be such as to ensure adequate representation of the pattern of health care - geographic location, teaching and not- teaching, secondary and tertiary, government, non-profit and corporate,’ said Dr Meenakshi Sharma scientist at ICMR.

The country will be divided into four regions. Four regional coordinator from North, South, East and Western regions of the country, along with ICMR will monitor the project. Individual states may be able to assess their healthcare system and undertake measures to reduce the burden of coronary heart disease.

To address the issue of obtaining datasets for hospital admissions, an interactive workshop on “Developing a web-based module for capturing Acute Cardiovascular Events (ACE) in hospital” was held in October 2006 in Delhi and was organized by the Indian Council of Medical Research (ICMR), New Delhi, in collaboration with WHO.

“A web based questionnaire will be used by the registries. The hospitals will complete the standard case report form CRF at each patient visit. The data from this source document will be entered on the e- CRF (ACE registry online questionnaire),” she added.

Symptom to door, door to needle and door to balloon time is crucial in the management of ACS and Indian doctors adhere to American College of Cardiology (ACC) the American Heart Association’s (AHA) 2004 guidelines as there are no Indian guidelines.

Cardiologists in the city welcome the move as this will help formulate Indian guidelines. “India needs a good database and a epidemiological study for long term planning for nation to prevent acute coronary syndrome events,” said Dr Anil Sharma interventional cardiologist at Lilavati Hospital in Mumbai.