Adherence to Quality Indicators for ST-Elevation Myocardial Infarction Management: An Egyptian Experience.
Marwan S Mahmoud1, Ayman K M Hassan1
1Department of Cardiology, Assiut University Heart Hospital, Assiut University, Assiut, Egypt.
Current Problems in Cardiology
|August 16, 2023
Summary
This study assessed ST-elevation myocardial infarction (STEMI) management in Egypt, finding high adherence to guidelines but delays in treatment times. Improving STEMI care in developing countries requires addressing logistical and network challenges.
Area of Science:
- Cardiology
- Public Health
Background:
- Coronary artery disease, particularly ST-elevation myocardial infarction (STEMI), poses a significant global health challenge.
- Adherence to guideline-directed therapy is crucial for improving patient outcomes in STEMI management.
Purpose of the Study:
- To evaluate adherence to quality indicators (QIs) for STEMI management.
- To identify areas for improvement in a developing country context, using a tertiary care center in Egypt as a case study.
Main Methods:
- Retrospective analysis of 870 STEMI patients undergoing primary percutaneous coronary intervention (PCI) from January to December 2022.
- Assessment of adherence to 15 predefined QIs, focusing on time metrics and guideline-directed medical therapy.
Main Results:
- High adherence (>90%) to guideline-directed medical therapy was observed.
- Significant delays were noted in time-sensitive metrics, such as first medical contact (FMC) to electrocardiogram (ECG) and FMC to device time, particularly for inter-facility transfers.
- Only 77% of patients achieved the recommended FMC to device time of <90 minutes.
Conclusions:
- STEMI management centers in developing countries can achieve high adherence to clinical guidelines and medical therapy.
- Key challenges remain, including transportation delays, limited primary PCI center availability, communication network deficiencies, and financial constraints.
- Targeted interventions to optimize patient transfer and reduce system delays are essential for improving STEMI care in resource-limited settings.
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