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

Acute myocardial infarction (AMI) morbidity and mortality differs between Asia-Pacific countries and is contributed to by differences in systems of care. This article elaborates on how systems of care can be improved. Suggestions include: 1) Patient education on AMI symptoms and need to activate emergency medical services (EMS); 2) Developing robust, centralized and well-coordinated EMS; 3) Performing pre-hospital electrocardiogram with onward transmission and video telemedicine triage; 4) Setting up geographically oriented ST elevation myocardial infarction networks; 5) Employing algorithms to diagnose high-risk AMI; 6) Adhering to clinical practice guidelines and integrated care pathways; 7) Creating AMI registries and auditing outcomes. 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.