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Improving STEMI Management Internationally: Initial Report of the American College of Cardiology-Global Heart Attack
Cesar J Herrera1, Benny J Levenson2, Angela Natcheva3
1CEDIMAT Cardiovascular Center, Santo Domingo, Dominican Republic, and Montefiore-Einstein Center for Heart and Vascular Care, New York, USA.
Insights
The Global Heart Attack Treatment Initiative (GHATI) improved ST-segment elevation myocardial infarction (STEMI) care in low-resource countries. This initiative observed a 2% improvement in combined endpoints and increased survivorship, demonstrating progress in STEMI management.
Area of Science:
- Cardiovascular Medicine
- Public Health
- Health Services Research
Background:
- ST-segment elevation myocardial infarction (STEMI) is a growing global health concern, particularly in low- and middle-income countries (LMICs) with limited resources.
- Data on system-based initiatives for STEMI management in LMICs are scarce, highlighting a critical gap in care.
- The increasing burden of STEMI necessitates focused strategies for improving patient outcomes in resource-constrained settings.
Purpose of the Study:
- To improve evidence-based STEMI care and guideline adherence in LMICs through the Global Heart Attack Treatment Initiative (GHATI).
- To establish a system for tracking clinical and institutional indicators of STEMI care in LMICs.
- To analyze the process of care and patient outcomes for STEMI in LMICs.
Main Methods:
- Prospective analysis of selected STEMI metrics from the American College of Cardiology Chest Pain MI Registry.
- Inclusion of 18 international hospitals, primarily in developing countries, in the initial phase of GHATI (2019-2021).
- Enrollment of 3,914 STEMI patients with complete data for analysis.
Main Results:
- A 2% improvement in combined endpoints (shock, arrest, low ejection fraction, survival) was observed over time.
- Survivorship at discharge increased by 2% (P = 0.003).
- High rates of guideline adherence (91.8%), reperfusion therapy (94.2%), and timely intervention (74.8% with first medical contact to device time <90 minutes) were achieved.
Conclusions:
- The GHATI registry successfully enrolled STEMI patients in countries new to quality improvement metrics.
- Observed trends indicate improvements in STEMI care delivery and patient outcomes in participating LMICs.
- GHATI holds potential for facilitating global cardiovascular disease outcome enhancement, especially in evolving economies.
Background:
The burden of ST-segment elevation myocardial infarction (STEMI) worldwide is increasing as the leading cause of death; there are scant data on system-based initiatives and performance metrics relative to its management in low- and middle-income countries where resources are frequently limited.
Objectives:
The Global Heart Attack Treatment Initiative (GHATI) ultimate aim is improving evidence-based STEMI care, adherence to guidelines, and tracking of clinical and institutional indicators in low- and middle-income countries. To achieve that goal, the process of care and outcomes of STEMI patients in those nations will be studied.
Methods:
In this initial phase of GHATI (2019-2021), prospective analyses of selected STEMI metrics derived from the American College of Cardiology Chest Pain MI Registry were undertaken in 18 international hospitals, most located in developing countries unfamiliar with quality improvement metrics.
Results:
Of 4,092 patients enrolled, complete data were available in 3,914 consecutive STEMIs included here: 80.5% male; 35.5% smokers; shock on arrival in 10%; and 5.1% with cardiac arrest before intervention. Overall, a 2% improvement on combined endpoints (shock; arrest before or after intervention; final ejection fraction <40%; survival at discharge) was observed over time, and survivorship also increased by 2% (P = 0.003). First medical contact to device time <90 minutes occurred in 74.8%; reperfusion therapy in 94.2%; and adherence to guidelines in 91.8%.
Conclusions:
This global contemporary registry successfully enrolled STEMI patients in nations generally unfamiliar with quality improvement metrics; trends of improvement in their care were observed. GHATI may facilitate implementation of policies aimed at enhancing outcomes of cardiovascular disease worldwide, particularly in countries with evolving economies.
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