ACC Global Heart Attack Treatment Initiative Shows Benefits in Improving Care in Low-, Middle-Income Countries

The ACC Global Heart Attack Treatment Initiative (GHATI) had measurable positive impacts on care delivery for heart attacks in low- and middle-income countries, according to data from the program's first year presented May 17 during ACC.21.

The ACC launched GHATI in 2019 to improve heart attack outcomes in low- and middle-income countries by encouraging adherence to guideline-directed medical therapy. While a person who suffers a heart attack in the U.S. or Europe has a 95-97% chance of survival, the odds are significantly worse in low- and middle-income countries, where the chance of survival is 80-90%.

Data from the first year of the program, reflecting STEMI treatment metrics and outcomes for more than 2,000 patients at 18 medical centers in 13 countries on four continents, reveal that around 90% of hospital admissions for a heart attack adhered to guideline-directed medical therapy. At the same time, the average time patients spent in transit to the hospital decreased by 38 minutes; cardiac arrest upon arrival decreased by 4.6%; and the time from first medical contact to the use of a device to open blocked arteries improved by 28%. All these factors are known to improve outcomes after a heart attack.

While the study is not a randomized controlled trial and cannot definitively attribute the improvements to the program, feedback from participants and a robust body of previous research on quality improvement suggests that the program has helped to encourage positive change, according to the researchers.

"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," said Benny J. Levenson, MD, PhD, FACC, of CV Center Berlin-Charlottenburg, Vivantes Klinikum Am Urban/Berlin in Germany and immediate past chair of GHATI. "We were pleased that the results, at one 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 heart attack and ultimately make a big impact on reducing mortality."

GHATI brings together ACC experts from around the world, including members of the College's Assembly of International Governors, with cardiology teams at participating institutions to establish systems for tracking patient encounters and collecting data on outcomes. Levenson said the program will continue to expand into more sites and countries, including top-performing medical centers and higher-income countries.

"The benefit to participating institutions starts with participating," Levenson said. "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."

The ACC GHATI Work Group is led by Chair Cesar Herrera, MD, FACC, the Americas Representative for ACC's Assembly of International Governors, and director of CEDIMAT Cardiovascular Center in Santo Domingo, Dominican Republic, and B. Hadley Wilson, MD, FACC, chair-elect of the ACC Governance Committee and a cardiologist at Sanger Heart and Vascular Institute in Charlotte, NC.

"GHATI has been a real team effort, both by members of the Assembly of International Governors and within the ACC GHATI working group providing the program leadership," said Levenson.

More information about GHATI is available at

Clinical Topics: Acute Coronary Syndromes, Prevention, Stable Ischemic Heart Disease, Vascular Medicine, Chronic Angina

Keywords: ACC Annual Scientific Session, ACC21, Primary Prevention, Acute Coronary Syndrome, ST Elevation Myocardial Infarction, Myocardial Infarction, Angina, Unstable, ACC International

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