Creating STEMI Program in India

posted Jan 25, 2017, 11:10 PM by sourav ghosh   [ updated Jan 26, 2017, 5:36 AM ]
Ajit Mullasari 
Director, Cardiology, The Madras Medical Mission, Chennai, India

The burden of cardiovascular disease is increasing at an unprecedented rate in the low and middle income countries (LMICs) because of ageing population, widespread exposure to increasing levels of risk factors such as unhealthy diet, physical inactivity, obesity, tobacco use, diabetes, raised blood pressure and abnormal blood lipids.The consequences of globalization and urbanization are also contributory factors.
There are no accurate estimates of STEMI in the LMIC, but it is possible that there could be upwards of 3 million cases per year.The almost universal use of Primary PCI as the reperfusion therapy of choice in ST-Elevation Myocardial Infarction (STEMI) and utilization of other evidence based medications, has dramatically improved the results of STEMI management in the United States and Western Europe.
The challenges for LMIC in Asia and Africa are entirely different.Regional Systems of care for STEMI care are virtually non-existent. Cardiac catheterisation laboratories are inadequate in number to serve the large numbers of patients with STEMI and are almost always clustered in urban locations.Poor transportation infrastructure, lack of adequately trained and equipped paramedics and ambulances, make access to these invasive centres difficult.Added to this is the financial constraints and lack of insurance coverage for the large majority of the population that limit these expensive procedures and costly medications to a small proportion of the patients.
In an environment of resource constraints with a burgeoning population of patients in LMIC with STEMI who require emergency care, the challenge is to address these issues in an effective and equitable manner.For this, innovation, particularly the use of technology can help deliver reperfusion for all.
This TNSTEMI project tries to address the management of STEMI and to utilize algorithms of STEMI management that may be more appropriate and easier to implement in LMIC.