Acute coronary syndrome treatment delay in low to middle-income countries: A systematic review

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.

Number of standard modifiable risk factors and mortality in patients with first-presentation ST-segment elevation myocardial infarction: insights from China Acute Myocardial Infarction registry

“…Besides, patients with fewer SMuRFs were also accompanied with other poor risk profiles (more females, poorly educated, and admitted to county-level hospitals). Previous studies have reported that those unfavorable factors, as well as the existence of those individual components of SMuRFs, were associated with longer pre-hospital delay [ 26 – 28 ], which was consistent with our finding that patients with no SMuRF experienced significantly longer time from onset to FMC compared with their counterparts. Thus, this might also explain the clear differences in severity of illness at admission that patients with fewer SMuRFs presented with higher GRACE risk scores.…”

Knowledge, Attitudes and Beliefs About Acute Coronary Syndrome Among Patients Diagnosed With Acute Coronary Syndrome, Addis Ababa, Ethiopia

“…It is estimated that for every 1-minute delay to treatment, there is an 2% increase in mortality [41]. Use of EMS is an essential service that has been shown to reduce delay in ACS treatment in LMICs [42]. In the present study, the majority preferred for someone to drive them to the hospital rather than have EMS come to their home.…”

Barriers and enablers in the implementation of a quality improvement program for acute coronary syndromes in hospitals: a qualitative analysis using the consolidated framework for implementation research

“…Most IHD deaths are from acute coronary syndromes (ACS), particularly in developing countries such as China [ 8 ]. Previous studies have identified numerous challenges in ACS treatment, including systematic delays and poor and unequal quality across different regions [ 9 – 13 ]. Time is critical for patients, and early diagnosis and treatment following clinical pathways are crucial to improving ACS care quality [ 14 ].…”