Implementing and tracking quality improvement (QI) metrics may lead to improved outcomes in patient care after STEMI in low- and middle-income countries (LMIC), according to an analysis of data from the ACC's Global Heart Attack Treatment Initiative (GHATI) published in JACC: Advances.

The study analyzed data from the initial phase of the GHATI program between 2019 and 2021, during which 18 hospitals across seven LMIC countries implemented select QI metrics derived from ACC's Chest Pain – MI Registry and tracked adherence to guideline-directed medical therapies. The majority of hospitals were tertiary care centers in large urban areas with fewer than 300 beds, and while most were equipped with catheterization laboratories, they were not part of a STEMI network and had no prior experience in registries or QI programs.

All told, data were available on 3,914 consecutive STEMI patients, of which 80.5% were male, 35.5% were smokers, 10% experienced shock on arrival, and 5.1% had cardiac arrest before intervention. According to Cesar J. Herrera, MD, FACC, et al., 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%. Additionally, the first medical contact to device time <90 minutes occurred in 74.8%; reperfusion therapy in 94.2%; and adherence to guidelines in 91.8%.

"Information on the status of contemporary evidence-based STEMI care in LMICs are limited, and little information exists in the implementation and sustainability of Acute Myocardial Infarction QI programs in these nations," write the authors. "In this prospective registry involving several countries across multiple continents, we learned that implementing such efforts is a feasible endeavor."

The authors stress the importance of comprehensive buy-in from governments, clinicians, community organizations and others, in support of public education on the early recognition of the signs and symptoms of heart disease; "advanced cardiac life support training of providers; multidisciplinary training of physicians in urgent care centers toward timely diagnosis and therapy of STEMI; strengthening pharmaco-invasive strategies is distant rural areas; and supporting the creation of STEMI networks."

GHATI has since expanded to sites in Brazil, Costa Rica, Cuba, Egypt, India, Iran, Kenya, North Macedonia, Paraguay, Peru, Serbia, Singapore and United Arab Emirates, and the Initiative plans to continue long-term follow-up.