• Willem Stassen, Lisa Kurland, Lee Wallis, Maaret Castren, and Craig Vincent-Lambert.
• Department of Clinical Research and Education, Karolinska Institutet.
• Afr Health Sci. 2020 Mar 1; 20 (1): 338-350.

BackgroundST-elevation myocardial infarction (STEMI) is on the rise in sub-Saharan Africa. South Africa consistently fails to deliver timely reperfusion to these patients, possibly due to under-developed coronary care networks (CCN).ObjectivesTo determine the current perceived state of CCNs, to determine the barriers to optimising CCNs and to suggest facilitators to optimising CCNs within the South African context.MethodsA qualitative descriptive approach was employed, by performing two structured in-depth and two focus group interviews (n=4 and 5, respectively), inviting a purposely heterogeneous sample of 11 paramedics (n=4), doctors (n=5), and nurses (n=2) working within different settings in South African CCNs. Recorded interviews were transcribed verbatim and subjected to content analysis.ResultsParticipants described an under-resourced, unprioritised and fragmented CCN with significant variation in performance. Barriers to CCN optimisation resided in recognition and diagnosis of STEMI, transport and treatment decisions, and delays. Participants suggested that thrombolysing all STEMI patients could facilitate earlier reperfusion and that pre-hospital thrombolysis should be considered. Participants highlighted the need for regionalised STEMI guidelines, and the need for further research.ConclusionNumerous barriers were highlighted. Healthcare policy-makers should prioritise the development of CCNs that is underpinned by evidence and that is contextualised to each specific region within the South African health care system.© 2020 Stassen W et al.

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