Bridging the gap in acute coronary syndrome care in low and middle income countries through a digital platform

Abstract Background ST-elevation myocardial infarction (STEMI) remains a major cause of mortality in resource-limited countries. Initiation of appropriate therapy and timely reperfusion are often delayed due to a lack of ECG interpretation expertise, limited specialist availability, and geographic barriers, leading to a five-fold increase in mortality. Additional challenges include the absence of an organized STEMI care system, financial constraints, and fragmented referral pathways. Cardiovascular diseases impose a significant economic burden, with costs in low- and middle-income countries (LMICs) projected to reach 3. 76 trillion by 2025. Digital health solutions, particularly telemedicine-driven ECG interpretation and triage systems, offer a promising approach to reducing diagnostic delays and optimizing referral strategies. However, their success depends on real-time specialist involvement to ensure adherence to guideline-directed care. Using a Triage-Treat-Transfer (T3) approach, the system could enable early STEMI and high-risk Acute Coronary Syndrome (ACS) recognition through rapid ECG interpretation, point-of-care ultrasound, and troponin assays. Purpose This study evaluated the feasibility of a digital platform in improving STEMI and high-risk ACS management by reducing referral delays and enhancing adherence to guideline-directed medical therapy. Methods The platform was deployed across community clinics and mobile heart camps, enabling real-time expert consultation for suspected STEMI cases. Local physicians transmitted ECGs securely for automated STEMI detection and cardiologist validation. Patients were triaged based on clinical risk and ECG findings, guiding decisions on urgent reperfusion therapy, a pharmaco-invasive strategy when percutaneous coronary intervention (PCI) was unavailable, or high-risk monitoring. High-risk patients were prioritized for transfer to PCI-capable centers. Results The digital platform significantly enhanced STEMI and high-risk ACS care delivery, streamlining diagnosis and treatment. A total of 211 patients were evaluated for suspected ACS, with 51 confirmed cases, all received guideline-directed therapy. Of the 12 transferred, 8 underwent PCI, 1 required coronary artery bypass surgery, and 3 continued on optimal medical therapy post-angiography. Interim results show improved STEMI recognition, structured triage, and faster intervention, reducing unnecessary admissions and transfers. Conclusions A digital platform–enhanced acute cardiac care model, with real-time cardiologist guidance, structured triage, and expedited transfers, is a scalable and cost-effective strategy for improving STEMI and high-risk ACS outcomes in resource-limited settings. By integrating real-time ECG interpretation and expert decision support, this model may optimize early reperfusion, reduce mortality, and lower healthcare costs. Future trials and broader network integration could enhance its impact.