Resource and infrastructure-appropriate management of ST-segment elevation myocardial infarction in low- And middle-income countries

Y. Chandrashekhar, Thomas Alexander, Ajit Mullasari, Dharam J. Kumbhani, Samir Alam, Erick Alexanderson, Damodar Bachani, Jacobus Cornelius Wilhelmus Badenhorst, Ragavendra Baliga, Jeroen J. Bax, Deepak L. Bhatt, Eduardo Bossone, Roberto Botelho, Rabindra Nath Chakraborthy, Richard A. Chazal, Rupinder Singh Dhaliwal, Habib Gamra, Sivadasan Pillai Harikrishnan, Mohamed Jeilan, David Ian KettlesSameer Mehta, Padhinhare P. Mohanan, Christoph Kurt Naber, Nitish Naik, Mpiko Ntsekhe, Harun Argwings Otieno, Prem Pais, Daniel José Piñeiro, Dorairaj Prabhakaran, K. Srinath Reddy, Mustafa Redha, Ambuj Roy, Meenakshi Sharma, Robert Shor, Frederik Adriaan Snyders, Jack Weii Chieh Tan, C. Michael Valentine, B. Hadley Wilson, Salim Yusuf, Jagat Narula

Research output: Contribution to journalArticle

Abstract

The 143 low- and middle-income countries (LMICs) of the world constitute 80% of the world's population or roughly 5.86 billion people with much variation in geography, culture, literacy, financial resources, access to health care, insurance penetration, and healthcare regulation. Unfortunately, their burden of cardiovascular disease in general and acute ST-segment-elevation myocardial infarction (STEMI) in particular is increasing at an unprecedented rate. Compounding the problem, outcomes remain suboptimal because of a lack of awareness and a severe paucity of resources. Guideline-based treatment has dramatically improved the outcomes of STEMI in high-income countries. However, no such focused recommendations exist for LMICs, and the unique challenges in LMICs make directly implementing Western guidelines unfeasible. Thus, structured solutions tailored to their individual, local needs, and resources are a vital need. With this in mind, a multicountry collaboration of investigators interested in LMIC STEMI care have tried to create a consensus document that extracts transferable elements from Western guidelines and couples them with local realities gathered from expert experience. It outlines general operating principles for LMICs focused best practices and is intended to create the broad outlines of implementable, resource-appropriate paradigms for management of STEMI in LMICs. Although this document is focused primarily on governments and organizations involved with improvement in STEMI care in LMICs, it also provides some specific targeted information for the frontline clinicians to allow standardized care pathways and improved outcomes.

Original languageEnglish (US)
Pages (from-to)2004-2025
Number of pages22
JournalCirculation
DOIs
StateAccepted/In press - 2020

Keywords

  • Coronary artery disease
  • Electrocardiography
  • Health policy
  • LMICs
  • Percutaneous coronary intervention
  • Telemedicine
  • Thrombolytic therapy
  • Universal health care

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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    Chandrashekhar, Y., Alexander, T., Mullasari, A., Kumbhani, D. J., Alam, S., Alexanderson, E., Bachani, D., Wilhelmus Badenhorst, J. C., Baliga, R., Bax, J. J., Bhatt, D. L., Bossone, E., Botelho, R., Chakraborthy, R. N., Chazal, R. A., Dhaliwal, R. S., Gamra, H., Harikrishnan, S. P., Jeilan, M., ... Narula, J. (Accepted/In press). Resource and infrastructure-appropriate management of ST-segment elevation myocardial infarction in low- And middle-income countries. Circulation, 2004-2025. https://doi.org/10.1161/CIRCULATIONAHA.119.041297