Socioeconomic Disparities and Clinical Trajectories in Acute Coronary Syndrome at a Tertiary Ethiopian Referral Center: A Retrospective Cohort Analysis of Epidemiological Profiles, Therapeutic Gaps, and Prognostic Determinants to Inform Contextually Adaptive Cardiac Care Delivery Models

Abstract

Background

Acute Coronary Syndrome (ACS) represents a spectrum of myocardial ischemic conditions that collectively constitute one of the foremost contributors to global cardiovascular morbidity and premature mortality. Over the past three decades, the epidemiological transition characterizing low- and middle-income countries (LMICs) has precipitated a marked upsurge in the incidence of cardiovascular diseases, with ACS emerging as a critical public health exigency. The World Health Organization estimates that nearly 80% of cardiovascular-related deaths now occur in resource-constrained settings, underscoring a shifting disease burden that increasingly challenges fragile health systems ill-equipped for acute cardiovascular care.

Objective

This study aimed to comprehensively characterize the clinical epidemiology, therapeutic management patterns, and in-hospital prognostic trajectories of patients diagnosed with Acute Coronary Syndrome (ACS) at Adama General Hospital a tertiary referral center in Ethiopia in order to identify modifiable care delivery gaps and generate  contextually relevant evidence to inform quality improvement initiatives in resource-limited cardiovascular care settings.

Methodology

A retrospective cohort design was employed, encompassing all patients admitted with a confirmed ACS diagnosis over a predefined study period, with demographic, clinical, laboratory, therapeutic, and outcome data systematically abstracted from electronic and paper-based medical records using standardized forms; primary endpoints included in-hospital mortality and major adverse cardiovascular events, while multivariable logistic regression was conducted to ascertain independent predictors of adverse outcomes, with adjustment for potential confounders.

Results

Among the included cohort (n = [X]; mean age: [Y] ± [Z] years; [A]% male), [B]% presented with ST-elevation myocardial infarction (STEMI) and [C]% with non-ST-elevation ACS, with hypertension ([D]%) and diabetes mellitus ([E]%) as the predominant comorbidities; reperfusion therapy was administered to only [F]% of patients thrombolysis in [G]% while the in-hospital mortality rate was [H]%, with cardiogenic shock ([I]%) and malignant arrhythmias ([J]%) as the most frequent complications, and delayed presentation exceeding 12 hours independently predicted mortality (adjusted odds ratio: [K]; 95% confidence interval: [L–M]).

Conclusion

ACS at Adama General Hospital is characterized by substantial morbidity and mortality, predominantly driven by prolonged prehospital delays and severely constrained access to reperfusion therapies, underscoring the imperative for targeted public health strategies to enhance community symptom awareness, strengthen prehospital emergency systems, and augment institutional capacity for timely acute cardiovascular care, with future research prioritizing longitudinal outcome assessments and systematic evaluation of barriers to implementing evidence-based guideline-directed therapy.