12 / 82
CARDIOVASCULAR JOURNAL OF AFRICA • Volume 29, No 1, January/February 2018
10
AFRICA
However, in practice most facilities (77%) are only accessible to
the 18% of patients with medical insurance.
15,34
Using epidemiological and geospatial data, formal referral
networks and guidelines could be developed that are contextual
to each specific region within South Africa (and Africa), and
that take into consideration the specific resources available and
the proximity to these resources. In addition, it is essential to
establish what the capacity and role of EMS is within the African
context to improve reperfusion times for patients suffering
myocardial infarctions.
Conclusion
Up to 72% of South Africans live within two hours of a
PCI facility, but timely access may not be possible because
of insurance status or other system delays. The incidence of
ischaemic heart disease is on the increase in South Africa. In
order to prepare for this epidemiological transition, there is a
pressing need to develop coronary care networks to provide
emergency care for these patients. Development of coronary care
networks should be prioritised by policy makers and tailored to
the specific proximity to 12-lead ECG, thrombolysis or PCI of
each community.
The authors acknowledge Matthew Rosenberg for his expert consultation
with ArcGIS on this project.
References
1.
Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V,
et
al
. Global and regional mortality from 235 causes of death for 20 age
groups in 1990 and 2010: a systematic analysis for the Global Burden
of Disease Study2010.
Lancet
2012;
380
: 2095–128. PMID: 23245604,
DOI: 10.1016/S0140-6736(12)61728-0.
2.
Lim S, Vos T, Flaxman A. Burden of disease and injury attributable to
67 risk factors in 21 regions, 1990–2010: a systematic analysis for the
global burden of disease study 2012.
Lancet
2012. PMID: 23245609,
PMCID: PMC4156511 DOI: 10.1016/S0140-6736(12)61766-8.
3.
Hertz JT, Reardon JM, Rodrigues CG, de Andrade L, Limkakeng
AT, Bloomfield GS,
et al
. Acute myocardial infarction in sub-Saharan
Africa: the need for data.
PLoS One
2014;
9
(5): e96688. PMID:
24816222, PMCID: PMC4016044, DOI: 10.1371/journal.pone.0096688.
4.
O’Gara PT, Kushner FG, Ascheim DD, Casey, Jr DR, Chung MK, de
Lemos JA,
et al
. 2013 ACCF/AHA Guideline for the management of
st-elevation myocardial infarction: a report of the American College
of Cardiology Foundation/American Heart Association Task Force
on Practice Guidelines.
Circulation
2013;
127
: 1–64. DOI: https://doi.
org/10.1161/CIR.0b013e3182742c84.
5.
Steg PG, Borger MA, James SK, Atar D, Blömstrom-Lundqvist C,
Badano LL. ESC guidelines for the management of acute myocardial
infarction in patients presenting with STEMI.
Eur Heart J
2012;
33
:
2569–2619. DOI: 10.1093/eurheartj/ehs215.
6.
Rao A, Kardouh Y, Darda S, Desai D, Devireddy L, Lalonde T,
et al
.
Impact of the prehospital ECG on door-to-balloon time in ST elevation
myocardial infarction.
Catheter Cardiovasc Interv
2010;
75
(2): 174–178.
PMID: 19806636, DOI: 10.1002/ccd.22257.
7.
Rathore SS, Curtis JP, Chen J, Wang Y, Nallamothu BK. Association
of door-to-balloon time and mortality in patients admitted to hospital
with ST elevation myocardial infarction: national cohort study.
Br Med
J
2009;
338
: b1807. DOI:
https://doi.org/10.1136/bmj.b1807.8.
McNamara RL, Wang Y, Herrin J. Effect of door-to-balloon time on
mortality in patients with ST-segment elevation myocardial infarction.
J
Am Coll Cardiol
2006;
47
: 2180–2186. PMID: 16750682, DOI: 10.1016/j.
jacc.2005.12.072.
9.
De Luca G, Suryapranata H, Ottervanger J, Antman E. Time delay to
treatment and mortality in primary angioplasty for acute myocardial
infarction: every minute of delay counts.
Circulation
2004;
109
(10): 1223–
1225. PMID: 15007008, DOI: 10.1161/01.CIR.0000121424.76486.20.
10. SAMA/Acute Coronary Syndrome Working Group. Management
of acute coronary syndromes clinical guideline.
S Afr Med J
2001;
91
(10.2):879–895.
11. Schamroth C, ACCESS South Africa Investigators. Management
of acute coronary syndrome in South Africa: insights from the
ACCESS (Acute Coronary Events – a Multinational Survey of Current
Management Strategies) registry.
Cardiovasc J Afr
2012;
23
(7): 365–370.
PMCID: PMC3721828, DOI: 10.5830/CVJA-2012-017.
12. Meel R, Gonçalves R. Time to fibrinolytics for acute myocardial infarc-
tion: Reasons for delays at Steve Biko Academic Hospital, Pretoria,
South Africa.
S Afr Med J
2015;
106
(1): 92–96. PMID: 26792315,
DOI:10.7196/SAMJ.2016.v106i1.9801.
13. Snyders A, Delport R. Referral pathways for reperfusion of STEMI
– developing strategies for appropriate intervention.
SA Heart
2015;
12
(2): 74–80.
14. Peterson MC, Syndergaard T, Bowler J, Doxey R. A systematic review
of factors predicting door to balloon time in ST-segment eleva-
tion myocardial infarction treated with percutaneous intervention.
Int J Cardiol
2012;
157
(1): 8–23. PMID: 21757243, DOI: 10.1016/j.
ijcard.2011.06.042.
15. Stassen W, Wallis LA, Lambert C, Castren M, Kurland L. Percutaenous
coronary intervention still not accessible for many South Africans.
Afr
J Emerg Med
2017;
7
(3):105–107. DOI: 10.1016/j.afjem.2017.04.009.
16. Statistics South Africa. Census 2011 Statistical release – P0301.4.
Pretoria: Statistics South Africa; 2012.
17. Tordella SJ. How to relate to centroids.
American Demographics
1987;
9
(5): 46–50.
18. Nallamothu BK, Bates ER, Wang Y, Bradley EH, Krumholz AM.
Driving times and distances to hospitals with percutaneous coronary
intervention in the United States: implications for prehospital triage
of patients with STEMI.
Circulation
2006;
113
: 1189–195. PMID:
16520425, DOI: 10.1161/CIRCULATIONAHA.105.596346.
19. Goudevenos JA, Korantzopoulos P, Papathanasiou A, Kalantzi K,
Pipilis AG, Katsouras CS,
et al.
How many cath labs do we need to
perform primary percutaneous coronary interventions in a particular
population?
Int J Cardiol
2008;
129
: 292–293. PMID: 17643532, DOI:
10.1016/j.ijcard.2007.06.052.
20. Harris B, Goudge J, Ataguba J, McIntyre D. Inequities in access to
health care in South Africa.
J Public Health Policy
2011;
32
(S1): S102–
103. PMID: 21730985, DOI: 10.1057/jphp.2011.35.
21. Ataguba JE, Akazili J, McIntyre D. Socioeconomic-related health
inequality in South Africa: evidence from General Household Surveys
.
Int J Equity Health
2011;
10
(48): 1–10. PMID: 22074349, PMCID:
PMC3229518, DOI: 10.1186/1475-9276-10-48
22. Bisanzo M. The Frontline of emergency cardiac care in Africa.
Afr J
Emerg Med
2014;
4
(3): 102–103.
23. Kwazulu-Natal Provincial Government. Annual Report, Department of
Health; 2015–2016.
24. Meents E BT. Emergency medical services: poor response time in the
rural Eastern Cape.
S Afr Med J
2010;
100
(12): 790. PMID: 21414262.
25. Wachira BW, Owuor AO, Otieno HA. Acute management of
ST-elevation myocardial infarction in a tertiary hospital in Kenya: