Vol. 48 | No. 2 | July-December 2020 Back

Open Access

The Epidemiologic Burden of Hospitalization for Coronary Artery Disease Among Adults Aged 19 years and above in the Philippines

Abstract

INTRODUCTION: Most deaths from cardiovascular disease result from coronary artery disease (CAD). In the country, it consistently has been the most common cause of overall mortality for the last 10 years.

OBJECTIVE AND METHODOLOGY: The study aimed to determine the prevalence of hospitalization due to CAD using data collected from PhilHealth hospitalization claims from January 1 to December 31, 2017. The data retrieved included the demographic profile, management done, duration of hospitalization, facility type, and condition on discharge. Data analysis was done using median and interquartile range for continuous data, and frequency and percent distribution for categorical data.

RESULTS: There were a total of 7,739,396 PhilHealth medical and procedural claims for adult Filipino patients in 2017. Of the total claims, 2,787,401 were for medical conditions, with 51,053 claims for CAD (42,866 claims for medically managed cases and 8,187 claims for those with invasive procedures). This translated to an estimated prevalence rate of 1.8% or 1,831 claims for CAD for every 100,000 PhilHealth hospitalization claims for a medical condition. The majority of patients were male (57.4%), with a median age of 63 years. There were 42,328 claims (82.9%) for acute coronary syndrome (ACS) among the claims for CAD. The median (quartile 1, quartile 3) length of hospitalization for CAD patients who received pharmacologic therapy alone was 4 (3, 6) days, whereas it was 3 (1, 5) days for those who underwent procedures. Only 162 admissions (0.4%) had invasive procedures done during the index hospitalization. The overall in-hospital mortality rate for CAD claims who received only pharmacologic therapy was 9.2%. For CAD patients who underwent invasive procedures, the in-hospital mortality rate was 1.7%. The in hospital mortality for ACS patients who received pharmacologic therapy alone was 9.2%. For ACS patients with an invasive procedure done during the index hospitalization, it was 5.6%.

CONCLUSION: In 2017, hospitalization claims for CAD were 1.8% or 1,831 claims for every 100,000 PhilHealth claims for a medical condition. The majority of CAD patients were admitted for an ACS. Most of the ACS patients were given pharmacologic therapy alone. Low revascularization rate on index admission was noted.

KEYWORDS: coronary artery disease, acute coronary syndrome, prevalence, mortality

  1. The 2015 Philippine Health Statistics. Epidemiology Bureau Department of Health. https://www.doh.gov.ph/sites/ default/files/publications/2015PHS.pdf. Accessed January 28, 2019.
  2. The 2014 Philippine Health Statistics. Epidemiology Bureau Department of Health. https://www.doh.gov.ph/sites/ default/files/publications/2014PHS_PDF.pdf. Accessed January 28, 2019.
  3. The 2013 Philippine Health Statistics. Epidemiology Bureau Department of Health. https://www.doh.gov.ph/sites/ default/files/publications/2013PHScompressed_0.pdf. Accessed March 27, 2018.
  4. Protocol for the Global Burden of Diseases, Injuries, and Risk Factors study (GBD). Version 3. Institute for Health Metrics and Evaluation. Issued 26 February 2018. http:// www.healthdata.org/sites/default/files/files/Projects/GBD/ GBD_Protocol.pdf. Accessed February 1, 2019.
  5. Institute for Health Metrics and Evaluation. Global Burden of Disease. Country profile: Philippines. http://www. healthdata.org/Philippines. Accessed February 1, 2019.
  6. 2014 PHA clinical practice guidelines for the diagnosis and management of patients with coronary heart disease. ASEAN Heart J 2016; 24(1):27–78.
  7. The Revised Implementing Rules and Regulations of the National Health Insurance Act of 2013 (RA 7875 As Amended By RA 9241 And 10606). https://www.philhealth. gov.ph/about_us/IRR_NHIAct_2013.pdf. Accessed December 18 , 2017.
  8. International Statistical Classification of Diseases and Related Health Problems, 10th Revision. https://icd.who. int/browse10/2016/en. Accessed January 2018.
  9. Annex 2. List of procedure case rates. https://www. philhealth.gov.ph/circulars/2013/annexes/circ35_2013/ Annex2_ListOfProcedureCaseRates.pdf. Accessed January 2018.
  10. National QuickStat by Year, January 2019, Philippine Statistics Authority. https://psa.gov.ph/statistics/quickstat/ national-quickstat/2019/%2A. Accessed January 31 2019.
  11. Tumanan-Mendoza BA, Mendoza VL, Bermudez-Delos Santos AA, et al. Epidemiologic burden of hospitalisation for congestive heart failure among adults aged ≥19 years in the Philippines. Heart Asia 2017;9(1):76-80. doi: 10.1136/ heartasia-2016-010862. eCollection 2017.
  12. Yaneza LO, Abanilla JM, Abola MTB, et al. Philippine Heart Association Acute Coronary Syndrome Registry—2 year results. PJC 2013;41(2):59-65.
  13. Beltejar-Pimentel, LMV, Iboleon-Dy, MA, Caole Ang, I. Obstructive CAD in Filipino men and women diagnosed with ACS in the Philippine ACS Registry. PJC 2017;45(1):31-44.
  14. Daida, H, Miyauchi, K, Ogawa, H, et al. Management and two-year long-term clinical outcome of acute coronary syndrome in Japan: Prevention of Atherothrombotic Incidents Following Ischemic Coronary Attack (PACIFIC) registry. Circ J 2013;77:934-943.
  15. Pocock SJ, Huo Y, Van de Werf F, et al. Predicting two-year mortality from discharge after acute coronary syndrome: an internationally-based risk score. Eur Heart J Acute Cardiovasc Care 2017:1-11.
  16. Huo Y, Lee SW, Sawhney JP, et al. Rationale, design, and baseline characteristics of the EPICOR Asia Study (Long tErm follow-uP of antithrombotic management patterns In Acute CORonary Syndrome patients in Asia). Clin Cardiol 2015; 38: 511–519.
  17. PhilHealth Circular No. 0035, Series 2013. All Case Rates Policy No. 2. Implementing guidelines on medical and procedures case rates. Philippine Star. Published December 17, 2013. https://www.philhealth.gov.ph/ circulars/2013/circ35_2013.pdf.
  18. PhilHealth Circular No. 0035, Series 2013. All Case Rates Policy No. 2. Implementing guidelines on medical and procedures case rates. Annex 4: examples and scenarios for the all case rates implementing guidelines. https://www. philhealth.gov.ph/circulars/2013/annexes/circ35_2013/ Annex4_Examples And Scenarios For The All Case Rates Implementing Guidelines.pdf.
  19. List of Medical Conditions and Procedures Allowed as Second Case Rate. https://lcp.gov.ph/images/PHIC_ ICD10/PHIC_ICD10_Annex3.pdf. Accessed July 2020.
  20. Sawhney JPS, Mullasari A, Kahali D, et al. Short- and long term follow-up of antithrombotic management patterns in patients hospitalized with acute coronary syndrome: Indian subgroup of EPICOR Asia study. Indian Heart J 2019;71:25-31.
  21. Jneid H, Addison D, Bhatt DL, et al. 2017 AHA/ACC clinical performance and quality measures for adults with ST-elevation and non–ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on performance measures. J Am Coll Cardiol 2017;70:2048–2090. doi: 10.1016/j. jacc.2017.06.032.
  22. O’Gara PT, Kushner FG, Ascheim DD, et al. 2013 ACCF/ AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on PracticeGuidelines. J Am Coll Cardiol 2013;61:e78–140. doi:10.1016/j.jacc.2012.11.019.
  23. Department of Health Administrative Order No. 2012-0012, Rules and Regulations Governing the New Classification of Hospitals and Other Health Facilities in the Philippines. https://uhmis.doh.gov.ph/edpms/pdf/legalBasis/ao2012- 0012.pdf. Accessed May 22, 2019.

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