PPCI network in Bosnia and Herzegovina
A STEMI network in Bosnia and Herzegovina was established in 2010 and is made up of six PCI-capable centres. Despite the increase in number of patients treated with PPCI after the network was implemented, the overall use of reperfusion therapy remains low, with as many as 41% of patients receiving no reperfusion therapy.
Barriers to rapid reperfusion
Pre-hospital barriers are related to infrastructure and patient education/delays. The main in-hospital barriers to treating STEMI patients in Bosnia and Herzegovina with PPCI is the lack of personnel – there is only a staggering 24 interventional cardiologists for nearly 4 million inhabitants – and a decline in insurance reimbursement. Post-procedure phase barriers are due to a lack of skilled medical staff to care specifically for PCI patients.
Dilic et al. have put out a call-to-action to address each barrier level in STEMI patient care, namely, patient education and campaigns (pre-hospital), increase use of fibrinolysis (tenecteplase) and possibly pharmaco-invasive strategy (in-hospital), and keeping health care professionals caring for STEMI patients up-to-date with technology and the latest evidence-based practices (post-procedure phase).
Overall, these systematic changes may improve access to reperfusion therapy throughout the Bosnia and Herzegovina.
- Dilic M, et al. Primary percutaneous coronary intervention network in Bosnia and Herzegovina: Where are we now and how to improve PCI network. Int J Cardiol 2016;217:S49-S51.