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Lynch A, Sobuwa S, Castle N. Barriers to the implementation of prehospital thrombolysis in the treatment of ST-segment elevation myocardial infarction in South Africa: An exploratory inquiry. Afr J Emerg Med. 2020;10(4):243-248doi: 10.1016/j.afjem.2020.08.001.
Lynch, A., Sobuwa, S., & Castle, N. (2020). Barriers to the implementation of prehospital thrombolysis in the treatment of ST-segment elevation myocardial infarction in South Africa: An exploratory inquiry. African journal of emergency medicine : Revue africaine de la medecine d'urgence, 10(4), 243-248. https://doi.org/10.1016/j.afjem.2020.08.001
Lynch, Andrew, et al. "Barriers to the implementation of prehospital thrombolysis in the treatment of ST-segment elevation myocardial infarction in South Africa: An exploratory inquiry." African journal of emergency medicine : Revue africaine de la medecine d'urgence vol. 10,4 (2020): 243-248. doi: https://doi.org/10.1016/j.afjem.2020.08.001
Lynch A, Sobuwa S, Castle N. Barriers to the implementation of prehospital thrombolysis in the treatment of ST-segment elevation myocardial infarction in South Africa: An exploratory inquiry. Afr J Emerg Med. 2020 Dec;10(4):243-248. doi: 10.1016/j.afjem.2020.08.001. Epub 2020 Sep 03. PMID: 33299757; PMCID: PMC7700957.
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Afr J Emerg Med. 2020 Dec;10(4):243-248. doi: 10.1016/j.afjem.2020.08.001. Epub 2020 Sep 03.

Barriers to the implementation of prehospital thrombolysis in the treatment of ST-segment elevation myocardial infarction in South Africa: An exploratory inquiry.

African journal of emergency medicine : Revue africaine de la medecine d'urgence

Andrew Lynch, Simpiwe Sobuwa, Nicholas Castle

Affiliations

  1. Department of Emergency Medical Care, Durban University of Technology, South Africa.
  2. Hamad Medical Corporation, Qatar.

PMID: 33299757 PMCID: PMC7700957 DOI: 10.1016/j.afjem.2020.08.001

Abstract

INTRODUCTION: Evidence-based guidelines advocate percutaneous coronary intervention (PCI) as the mainstay reperfusion strategy for ST-segment elevation myocardial infarction (STEMI). However, the South African health system is not well positioned to provide PCI as a 'mainstay strategy'. In response, the Health Professions Council of South Africa approved the use of prehospital thrombolysis (PHT) for emergency care practitioners in 2009. However, since its approval, prehospital thrombolysis has failed to reach a level of systematic uptake indicative of successful implementation. The current study aimed to explore, through a qualitative inquiry, barriers to PHT for the treatment of myocardial infarction within a South African context.

METHODS: A qualitative single-case study design was used where a series of semi-structured interviews were conducted involving purposefully selected participants. The case comprised a nationalised private emergency medical service, and participants were selected in view of relevant experience and knowledge. Requisite data was conceptualised through the consolidated framework for implementation research, and thematic analysis outlined the data coding procedures of the study.

RESULTS: The study identified potential barriers to the implementation of PHT. These comprised cost, logistics, inter-professional collaboration, leadership engagement, and beliefs or scepticism associated with PHT.

CONCLUSION: A lack of strategic implementation has resulted in a poor introduction of evidenced-based prehospital cardiac care, affecting vulnerable populations who may have otherwise benefited from receiving this level of care. Given the time-sensitive nature of STEMI management, and severely limited access to 'primary reperfusion', PHT resembles not only a logical but also appealing solution in the South African context.

© 2020 African Federation for Emergency Medicine. Publishing services provided by Elsevier.

Keywords: Acute myocardial infarction; Implementation; Prehospital coronary care; Prehospital thrombolysis; St-segment myocardial infarction

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