Background: In 2013, stroke and ischemic heart disease (IHD) became the leading causes of mortality and morbidity among adults over age 50 in China. Together they accounted for 3.29 million deaths and over 17% of years of life lost due to disability or premature mortality (DALYs). Despite the increased disease burden, there is a lack of adequate disease surveillance, particularly for acute CVD. This study aims to comprehensively assess the demand and supply for health care services for handling out-of-hospital cardiac arrest (OHCA) and ST-segment elevated myocardial infarction (STEMI) in Beijing and Shanghai, China.
Methods: A mixed methods approach was adopted. Household surveys were conducted to understand the needs and awareness of OHCA and STEMI. Furthermore, hospital and emergency medical service (EMS) surveys were carried out to determine existing system capacity in treating these conditions. Quantitative data were supplemented with qualitative data to better examine gaps in the delivery of services. A total of 1000 households, 3000 individuals, 4 major (tier one) facilities and 8 EMS stations were sampled in the two districts in each city.
Results: There was a lack of awareness among the general public in the symptoms of OHCA and STEMI. Delay in treatment was common. Willingness to carry out bystander action was low, and only a small proportion of individuals were CPR-trained. Results from hospital and EMS surveys indicated that facilities and ambulances were sufficiently equipped with technologies to handle OHCA and STEMI. However, timely diagnosis and treatments were hindered by various contextual factors including delays in treatment seeking, high patient volume and limitations in staff training and support.
Conclusion: The delivery of care for acute cardiac event in the two cities were suboptimal. Interventions are urgently needed. In particular, a holistic approach including the promotion of public knowledge, improvement in frontline health workers’ training and support, as well as enhancement of data registry and monitoring are necessary.