Barriers for Implementation of Guidelines Directed Management of Acute ST Elevated Myocardial Infarction (STEMI) Patients at Tertiary Care Hospitals in Bangladesh
DOI:
https://doi.org/10.67440/ahj.vi.2107Keywords:
Acute Coronary Syndrome, ST-segment elevation myocardial infarction, Barriers, Management, tertiary care hospitals.Abstract
Background: Prompt presentation, swift diagnosis, and prompt reperfusion are crucial for effective management of ST-segment elevation myocardial infarction (STEMI), but numerous patient- and system-related obstacles persist in hindering optimal care. The purpose of this study was to recognize obstacles to applying ESC 2023 guideline-recommended treatment for acute STEMI patients and to examine possible areas for enhancement in tertiary care hospitals in Bangladesh.
Methods: This cross-sectional observational study was conducted at BSMMU and NICVD, Dhaka, from October 2023 to September 2024. Data were collected using a structured questionnaire and analyzed with SPSS. Results were presented as mean ± SD and frequency/percentage. Multivariate logistic regression identified barriers to guideline-directed management, with p < 0.05 considered significant.
Results: Patients had an average age of 54.8 ± 12.4 years, with the majority being male (74.8%) and from middle-income categories (72.3%). Classic angina was observed in 87.3%. The predominant FMC was UHC (36.9%), succeeded by district hospitals (29.2%), whereas 13.5% accessed PCI-capable centers directly. Approximately 52.4% achieved PCI within 2–12 hours while 42.9% did so after 12 hours. Main obstacles included uncertainty regarding hospitalization (74.8%), financial limitations (84.5%), and unawareness of symptoms (54.9%), as well as systemic issues like delays in ECG, insufficient cath lab resources, a shortage of trained personnel, and transportation difficulties (69.3%).
Conclusion: Key barriers included low patient awareness, symptom ignorance, delayed decision-making, long distance, traffic congestion, limited 24/7 cath lab and intervention services, and insufficient CCU beds. Improving public education and strengthening healthcare systems are essential for guideline-based STEMI management.
