Current uses of ISACS-TC registry in Mostar Emir Fazlibegović a, ⁎, Ibrahim Terzić b , Mustafa Hadziomerovic a a Division of Cardiology, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina b BH Heart Center Tuzla, Tuzla, Bosnia and Herzegovina abstract article info Article history: Received 1 June 2016 Accepted 25 June 2016 Available online 27 June 2016 Cardiovascular disease (CVD) contributes greatly to inequalities in health in Europe. The acute myocardial infarc- tion (MI) in hospital death rate in Bosnia and Herzegovina is three fold higher than in European Union countries before the enlargement in 2004. There is also a striking difference in mortality between Bosnia and Herzegovina and Central and East European countries that joined the EU in 2004. Rapid development of high technology treat- ment procedures, which followed the economic recovery of the European Union countries, still have only limited influence on the overall control of MI death rate. Large potential to control MI death rate lies in developing PCI capable network with target to rapid reperfusion therapy in MI patients. The hypothesis that social factors may contribute to explain high MI death rate is attractive, but still is an assumption. However, if confirmed, transforming such knowledge into a practical health policy would be a great challenge. A resource-saving bal- anced assessment approach to health technology development is warrant in Bosnia and Herzegovina. An inter- national help is needed. © 2016 Elsevier Ireland Ltd. All rights reserved. Keywords: Bosnia and Herzegovina Acute myocardial infarction Primary percutaneous coronary intervention 1. Introduction Bosnia and Herzegovina (BiH) is a country with approximately 3.84 million inhabitants, with a geographic area of 51.197 km squared. It is administratively constituted by two entities: Federation of Bosnia and Herzegovina (FBiH) and Republika Srpska (RS) each with a high degree of autonomy. The city of Brčko in north-eastern Bosnia is a seat of the Brčko district. There are 10 cantons in FBiH and 6 regions in RS with overall 156 cities [1]. 1.1. Health systems and its subsystems in Bosnia and Herzegovina There are 3 University clinical Centers (Sarajevo, Tuzla and Mostar) and 3 regional centers (Zenica, Bihać and Goražde) in FBiH, whereas RS has 1 University clinical Center (Banja Luka) and 1 regional center (Foca-Istočno Sarajevo). There is also a Regional hospital in the Brcko district. There are 3 Ministries of Health and 3 Health Insurance Funds in FBiH, RS, and in the District. There are also 10 main institutions in state/entity/district level at Canton's level active in the field of social protection (Fig. 1). This structure highly influences the delivery of health care. In the “cardiac world” the introduction of the Stent for Life (SFL) [2,3] initiative played a pivotal role in improving health care for patients with acute myocardial infarction by creating a network of centers for cardiac catheterizations and percutaneous coronary intervention (PCI), which yielded improvement in the treatment of ischemic heart disease [4–6]. 1.2. Federation of Bosnia and Herzegovina and ISACS-TC It is estimated that in FBiH, the number of myocardial infarction (MI) per year is close to 7000, being more than 3100 of them ST-segment el- evation myocardial infarction (STEMI). In the 2015, the 6 centers for cardiac catheterization and PCI of FBiH performed 3085 PCI (1289 for primary PCI) [1] (Fig. 2). Only approximately 10% of these patients are enrolled in the Inter- national Survey of Acute Coronary Syndromes in Transitional Countries (ISACS-TC; ClinicalTrials.gov: NCT01218776) Registry [7–10]. There is room for improvement and greater participation of FBiH in the ISACS- TC Registry. The Mostar Center entered the ISACS-TC on January 2016. The ISACS-TC Registry contains large number for patients receiving care. Thus it may take over 30 min for compilation of data of a single pa- tient. The time and resources needed to collect and process data into this registry is sizeable. The registry will need to be best supported by defined stakeholders. The problem of implementing valid research re- sults in clinical practice is well known. Getting research into practice is not as simple as choosing an intervention and hoping for the best. Con- vincing over busy invasive cardiologists to start doing something new, such as routinely enroll patients in a registry may require a different strategy than that used to get cardiologists to stop doing something they do frequently. There are practical barriers to change, which need administrative/organizational support, and quality improvement struc- tures to address this issue. International Journal of Cardiology 217 (2016) S44–S46 ⁎ Corresponding author at: University Clinical Hospital Mostar, Lea Petrovića 4, 88000 Mostar, Bosnia and Herzegovina. E-mail address: emir.fazlibegovic@tel.net.ba (E. Fazlibegović). http://dx.doi.org/10.1016/j.ijcard.2016.06.224 0167-5273/© 2016 Elsevier Ireland Ltd. All rights reserved. Contents lists available at ScienceDirect International Journal of Cardiology journal homepage: www.elsevier.com/locate/ijcard