Acute coronary syndrome treatment delay in low to middle-income countries: A systematic review
Lemlem Beza1, Sharon L Leslie2, Bekele Alemayehu1
1College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
Insights
Prehospital treatment delays significantly worsen acute coronary syndrome (ACS) outcomes in low- to middle-income countries (LMICs). Addressing factors like transportation and rural access is crucial for improving patient survival rates.
Area of Science:
- Cardiology
- Public Health
- Health Systems Research
Background:
- Acute coronary syndrome (ACS) outcomes are improving in high-income nations but worsening in low- to middle-income countries (LMICs).
- Prehospital delays in treatment are a primary driver of poor ACS clinical outcomes in LMICs.
- Understanding factors contributing to these delays is essential for targeted interventions.
Purpose of the Study:
- To systematically review the literature on prehospital treatment delays for ACS in LMICs.
- To determine the average time from symptom onset to treatment.
- To identify sociodemographic, clinical, and health system factors associated with these delays.
Main Methods:
- A comprehensive systematic review of English-language literature from January 1990 to May 2020.
- Inclusion of 29 studies meeting predefined criteria.
- Definition of time to treatment as symptom onset to first medical contact, analyzed in relation to a 12-hour threshold.
Main Results:
- The mean time from symptom onset to first medical contact was 12.7 hours, with a wide range (10 minutes to 96 hours).
- Older age, female sex, illiteracy, rural residence, and financial limitations were associated with longer delays.
- Inadequate emergency transportation systems and poor communication between healthcare facilities were significant contributors.
Conclusions:
- Prehospital delays in ACS treatment are substantial in LMICs.
- Sociodemographic and health system factors critically influence treatment access.
- Interventions targeting these factors are needed to improve ACS outcomes in LMICs.
Abstract:
Although morbidity and mortality rates are declining for acute coronary syndrome (ACS) in most high-income countries, it is rising at an alarming pace for low to middle income countries (LMICs). A major factor that is contributing to the poor clinical outcomes among LMICs is largely due to prehospital treatment delays. This systematic review was conducted to determine the mean length of time from symptom onset to treatment in LMICs and the sociodemographic, clinical and health system characteristics that contribute to treatment delays. We conducted a comprehensive review of the relevant literature published in English between January 1990 through May 2020 using predefined inclusion and exclusion criteria. Twenty-nine studies were included and time to treatment was defined from ACS symptom onset to first medical contact and dichotomized further as less than or >12-hours. The mean time from symptom onset to first medical contact was 12.7 h which ranged from 10-minutes to 96 h. There was consensus among studies that being older, female, illiterate, living in a rural area, and financially limited was associated with longer treatment delays. Lack of a developed emergency transportation system, poor communication and organization between community facilities and interventional facilities were also cited as major contributors for ACS treatment delays. Findings from this systematic review provide future directions to potentially reduce prehospital delays in LMICs and improve ACS outcomes.
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