Implementation of a registry for acute coronary syndrome in resource-limited settings: barriers and opportunities.

Cardiovascular disease (CVD) is the leading cause of death in Egypt and worldwide, placing great strain on the world's health systems. High-quality treatment of CVD requires a valid, reliable measurement for ensuring evidence-based care. Clinical outcomes registries have been used to support quality improvement activities in some countries, but there are few examples of their implementation in resource-limited settings. A registry for acute coronary syndrome was piloted in 5 hospitals in Egypt, and observations regarding barriers and enabling factors related to implementation are summarized. Themes that emerged from daily observations include the importance of rapid cycles of change, the need to build a culture of applied research, the importance of modeling a blame-free culture, and key constraints encountered related to human resources and technical infrastructure. This pilot demonstrates that clinical registries may be a cost-effective investment in data infrastructure to support quality improvement in low- and middle-income countries.