Etiology, management, and outcomes of patients with coronary artery disease in a resource-poor Indonesian setting Learning from the local evidence

This thesis aims to capture a general picture of the current state of atherosclerotic cardiovascular disease (CVD) in the low-to-middle income South-East Asian population, particularly in Indonesia. As relatively little investigation has been done in this area, this thesis is dedicated to explore and study the unmet needs of cardiovascular practices in eastern Indonesia by identifying the risk factors, patient characteristics, management strategies, and outcomes that may be of considerable importance to the organization of local healthcare systems in the future. There are several important findings highlighted in this thesis: - There exists a significant association between childhood infections and maternal pregnancy complications with the increased burden of atherosclerotic CVD in Indonesia. - In a resource-poor Indonesian setting, it is a life-saving priority to improve early awareness of CVD symptoms, to be followed by guidelines-based diagnosis and treatment. - To optimize patients’ outcomes in Indonesia, the cardiovascular care should focused on control of cardiovascular risk factors, patient education, inter-professional teamwork, and logistics. - The root causes of excess mortality in patients with coronary artery disease in Indonesia are the initial severity of disease, lack of access to the guideline-recommended treatments, and poor adherence to medications.- The adherence to coronary angiography recommendations is too low and must be improved despite the resources-limited Indonesian setting. - The availability of standard screening for cardiovascular risk factors will save lives and reduce disability in Indonesia, and must therefore be made available and affordable at primary care level immediately, particularly for the low-to-middle income populations.