ST-Elevation Myocardial Infarction Systems of Care in Africa: A Scoping Review.

Background: ST-elevation myocardial infarction (STEMI) is a life-threatening, time-sensitive emergency. Cardiovascular diseases, including STEMI, are increasing on the African continent. Improving optimal outcomes for these patients requires a system-wide approach as the existing literature is unclear. Objectives: To describe and summarise the African literature on STEMI Systems of Care (STEMI SOC). Methods: This scoping review was designed following the PRISMA-ScR guidelines. An a priori search strategy was applied to EbscoHost, PubMed, and Google Scholar databases. Results: A total of 671 articles were identified. Following the exclusion of 619 articles, 52 articles were eligible for inclusion. STEMI patients in Africa are generally younger than their Western counterparts, present late to healthcare facilities, have insufficient healthcare insurance, and are non-adherent to discharge medication. Emergency medical services are lacking, there is a shortage of percutaneous coronary intervention (PCI) facilities, and emergency departments are disorganised. STEMI reperfusion times are delayed, data collection and quality assurance initiatives are inadequate, and STEMI referral networks and registries are underdeveloped. In addition, there is a deficiency of ECG and telemetry, a shortage of healthcare workers, a lack of adherence to guideline-recommended therapy, and a perceived hesitancy of medical personnel to administer fibrinolytics. These findings suggest a need for more clinical education. Conclusion: A myriad of barriers, as well as potential facilitators in the implementation of these networks, have been reported in this scoping review. The coordination and introduction of a STEMI SOC in African settings potentially holds great advantages, as has been witnessed in other low- and middle-income countries (LMICs) and high-income countries (HICs).