Treatment initiative improves STEMI care in low-income, middle-income countries
The American College of Cardiology’s Global Heart Attack Treatment Initiative had considerable positive influence on care delivery for MIs in low- and middle-income countries, according to a presentation at the ACC Scientific Session.
“It is obvious that there are chances to improve the systems and lower rates of cardiovascular death in low- and middle-income countries, and indeed in all countries. We were pleased that the results, at 1 year, were heading in the right direction. We intend to continue to grow this program to be a model for many other countries to improve systems of care for MI and ultimately make a big impact on reducing mortality,” Benny J. Levenson, MD, PhD, of CV Center Berlin-Charlottenburg, Vivantes Klinikum Am Urban/Berlin in Germany and immediate past chair of the Global Heart Attack Treatment Initiative (GHATI,) said in a press release.
B. Hadley Wilson, MD, FACC, executive vice chair of Atrium Health Sanger Heart & Vascular Institute and immediate past chair of the ACC’s membership committee and board of trustees, told Healio that STEMI systems of care have improved outcomes in the U.S. and Western Europe, so the ACC wanted to bring them to low- and middle-income countries.
“The organization wanted to work throughout their international chapters to bring the expertise of developing these systems of care and quality metrics to these places, and to offer assistance and guidance,” he said in an interview.
To assess the performance of the initiative, the researchers analyzed data elements taken from the ACC Chest Pain-MI Registry that were collected and reported quarterly by nine hospitals from low- and middle-income countries from October 2019 to September 2020, covering 1,073 consecutive STEMIs (19% women; 34.34% smokers; 9.49% with cardiogenic shock; 6.08% with cardiac arrest before intervention).
The researchers found that during the study period, transportation time decreased by 26.25 minutes; the proportion of patients who had first medical contact-to-device time of 90 minutes or less improved by 31% (one-sided P = .05); reperfusion therapy use was high; and adherence to guideline-directed medical therapy reached approximately 90%.
“These findings are indicators that clinical guidelines ... are read and followed globally,” Levenson said during a presentation.
“We were able to show, over the first year, quality improvement in several factors. The most important is that we reduced the transportation time of these MI patients globally in these nine centers. We also reduced the time from their first medical contact until they had open arteries or reperfusion,” Wilson told Healio. “We also reduced the number of those arriving in cardiac arrest, which is presumably because they got to the hospital sooner and got treatment sooner. We also significantly improved those that got guideline-directed medical therapy. Although we didn’t show a mortality difference so far, all those factors have been shown to reduce mortality after MI in other places.”
The initiative has expanded since its first year and is now in 18 centers, Wilson said.
“The benefit to participating institutions starts with participating. Places that have never collected data are now doing so. This leads to a culture change because people and institutions learn to look closely at their practices and discuss their results with others. Just by gathering data, we can start to see a positive effect,” Levenson said in the release.
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Levenson BJ, et al. Featured Clinical Research III. Presented at: American College of Cardiology Scientific Session; May 15-17, 2021 (virtual meeting).