Coronary care in China: starting from the tip of the iceberg?

In this issue of Heart, Yin and colleagues report an important piece of qualitative research on the barriers to early management of patients suffering an ST elevation myocardial infarction (STEMI) in the Guangdong region of China.1 China has a high burden of ischaemic heart disease (IHD) with myocardial infarction (MI) at the tip of the iceberg of cardiovascular disease which is among the leading causes of death in China. The age standardised mortality rate for IHD was 137/100 000 in 2016 and this has been rising.2 This burden of heart disease is driven by China’s ageing population, rapid economic growth and urbanisation, leading to changes in lifestyle factors, particularly high salt consumption and high levels of smoking. However, while the burden of IHD is highly linked to an estimated 1.7 million deaths in 2016, progress is being made on the broader category of cardiovascular disease with age standardised cardiovascular mortality falling nationally.2 The research by Yin is notable for two reasons: first, qualitative biomedical research originating in China is still unusual and shows a coming of age of the emerging Chinese research powerhouse in terms of adopting the full range of research methodologies in this setting; second, qualitative research is still relatively unusual in cardiovascular research and unusual in being published in Heart. The study explores the acute presentation of IHD, an important health issue globally, and for China in particular, and is important in exploring the strengths and weaknesses of its developing healthcare system. There is …