• acute coronary syndromes
• acute myocardial infarction
• global health care delivery
• quality and outcomes of care

Cardiovascular disease (CVD) is now the leading cause of mortality and morbidity worldwide, accounting for approximately one-third of all deaths globally.1 While popular belief presumes that non-communicable diseases (NCDs) afflict mostly high-income populations, the evidence tells a very different story. Nearly 80% of NCD deaths occur in low-income and middle-income countries (LMICs). Ischaemic heart disease (IHD) is the leading component of the global CVD burden.1 Mortality of IHD has decreased globally, especially in high-income countries (HICs), due to population-level changes in risk factors and to improvements in systems of care. Meanwhile, ageing of population, rapid economic growth, increasingly sedentary lifestyles and calorie-rich diets have increased the proportion of deaths attributable to CVD in many poorer regions of the world and, as a result, the mortality gap between LMIC and HIC over the past 20 years has narrowed.1

Improved systems of care, early detection and timely treatment are effective approaches for reducing the impact of CVD. However, appropriate care for people with NCDs is lacking in many settings, and access to essential technologies and medicines is limited, particularly in LMICs. In this context of scarce resources, it is imperative to get the most out of known effective interventions, such as the implementation of regional acute coronary syndrome (ACS) systems of care, lowering healthcare system delay (diagnosis, transportation and treatment), increasing reperfusion therapy and reducing in-hospital mortality.2 3

In their Heart manuscript, Galappatthy and colleagues4 presented the …