Identifying and Solving Gaps in Pre- and In-Hospital Acute Myocardial Infarction Care in Asia-Pacific Countries

Abstract

Acute myocardial infarction (AMI) is a major cause of morbidity and mortality in the Asia-Pacific region, and mortality rates differ between countries in the region. Systems of care have been shown to play a major role in determining AMI outcomes, and this review aims to highlight pre-hospital and in-hospital system deficiencies and suggest possible improvements to enhance quality of care, focusing on Korea, Japan, Singapore and Malaysia as representative countries. Time to first medical contact can be shortened by improving patient awareness of AMI symptoms and the need to activate emergency medical services (EMS), as well as by developing robust, well-coordinated and centralized EMS systems. Additionally, performing and transmitting pre-hospital electrocardiograms, algorithmically identifying patients with high risk AMI and developing hospital networks that appropriately divert such patients to percutaneous coronary intervention-capable hospitals have been shown to be beneficial. Within the hospital environment, developing and following clinical practice guidelines ensures that treatment plans can be standardised, whilst integrated care pathways can aid in coordinating care within the healthcare institution and can guide care even after discharge. Prescription of guideline directed medical therapy for secondary prevention and patient compliance to medications can be further optimised. Finally, the authors advocate for the establishment of more regional, national and international AMI registries for the formal collection of data to facilitate audit and clinical improvement.

Keywords: Acute myocardial infarction; Asia-Pacific; Healthcare systems; Pre-hospital care.

Figure 1. (A) Mortality rate of ischaemic heart disease in Asia versus only high-income Asia-Pacific countries, 1990–2019. (B) Morality rate of ischaemic heart disease in Japan, Singapore, Republic of Korea and Malaysia, 1990–2019. Lighter areas represent 95% confidence intervals for estimates. Data based on the Global Burden of Disease Study 2019.

Figure 2. Summary of suggestions for improvement to reduce ischaemia time and improve AMI care.

AI = artificial intelligence; AMI = acute myocardial infarction; ECG = electrocardiogram; STEMI = ST elevation myocardial infarction.