A retrospective description of acute coronary syndromes presenting to prehospital providers in the Western Cape, South Africa

Introduction: The growing prevalence of cardiovascular disease (CVD) in Africa remains a significant public health and socioeconomic issue. Disease manifestations include acute coronary syndrome (ACS) and, crucially, ST-segment myocardial infarction (STEMI), predominantly resulting in serious or long-term complications often overburdening healthcare systems. Comprehensive treatment strategies emphasising timely reperfusion of infarct-related arteries remain a crucial step in the management of acute coronary care. To achieve this, incidents of ACS - and specifically STEMI need to be described, especially considering settings where time to reperfusion might have been delayed significantly. The aim was to identify and detail incidents of ACS in the prehospital setting, specifically in the Western Cape, South Africa.

Methods: The study comprised a retrospective chart review of prehospital electronic patient care reports over a 12-month period (1 January 2018 to 31 December 2018). A provincial government emergency medical service (EMS) was sampled. Reports were analysed and descriptively summarised with eligibility criteria based on clinical findings indicative of ACS.

Results: A total of 975 ACS cases were included in the study. Extracted data were representative of a proportion of higher acuity cases, comprising red code (n = 869, 89.1%) and orange code (n 106, 10.9%) patient groups. STEMI was identified in 43 (4.4%) of cases, although deemed attributable to poor utilisation of electrocardiograms (ECGs) in order to support diagnosis, with no findings recorded in 787 (80.7%) of cases. Following STEMI diagnosis, aspirin was administered in fewer than half of all cases (n = 17, 39.5%).

Conclusion: Diagnostic 12-lead electrocardiography (ECG) is central to clinical decision-making in patients presenting with ACS, and limited utilisation could affect activation of referral pathways and delay reperfusion, ultimately worsening clinical outcomes. Further research is required to assess competencies, governance frameworks, and the availability of equipment. Despite low cost and high efficacy, aspirin was administered sub-optimally, raising doubt about clinical guideline adherence or uncertainty in diagnostic capabilities.