Implementing telemedicine in the initial care for ST-segment elevation myocardial infarction

Abstract

Background: In ST-segment elevation myocardial infarction, the need for early recanalization of the culprit artery, associated to the difficult access of the general population to medical services that provide such treatment, contribute to increased mortality in such patients. This is the rationale for implementing the LATIN project, acronym for Latin America Telemedicine Infarct Network, in areas characterized by high demographic density and difficult access to healthcare services. The objective of the present study was to analyze the first year results of this project. Methods: The sample included six centers with telemedicine systems participating in the LATIN registry. In cases of acute myocardial infarction, the electrocardiogram and clinical summary were sent to the mobile phones of the interventional cardiologists at the reference hospital. Clinical and angiographic characteristics, intervals between care delivered and hospital outcomes were analyzed. Results: From June 2014 to June 2015, a total of 125 patients were enrolled, mean age of 58.3±11.1 years, 66.4% males, 30.4% suffering from diabetes mellitus and 28.8% smokers. A total of 85 primary percutaneous coronary interventions were performed with a mean door-to-balloon time of 46.4±25.0 minutes. The pharmaco-invasive strategy was adopted in 20.0% of patients. In-hospital mortality was 5.6%. Conclusions: The telemedicine system was a valuable partner in early diagnosis and rapid initiation of the gold standard treatment for acute myocardial infarction in the region analyzed, with possible impact in survival, cost reduction and morbimortality. RESUMO -Introdução:No infarto agudo do miocárdio com supradesnivelamento do segmento ST, a necessidade de recanalização precoce da artéria culpada, associada às dificuldades de acesso da população em geral aos serviços médicos que realizam esta modalidade de tratamento, contribui para o aumento da mortalidade nesse perfil de paciente. Diante do exposto, encontra-se o racional de implementação do projeto denominado LATIN, acrônimo para Latin America Telemedicine Infarct Network, em áreas caracterizadas por concentração demográfica densa e dificuldades de acesso à saúde. O objetivo do presente estudo foi analisar os resultados do primeiro ano deste projeto. Métodos: A amostra compreendeu seis centros dotados de telemedicina participantes do registro LATIN. Nos casos de infarto agudo do miocárdio, eletrocardiograma e resumo clínico eram encaminhados por mensagem para os celulares dos cardiologistas intervencionistas do hospital de referência. Foram analisadas as características clínicas, angiográficas, os intervalos de atendimento e os desfechos hospitalares. Resultados: De junho de 2014 a junho de 2015, foram incluídos 125 pacientes, com média de idade de 58,3±11,1 anos, 66,4% do sexo masculino, 30,4% portadores de diabetes melito e 28,8% tabagistas. Foram realizadas 85 intervenções coronárias percutâneas primárias, com tempo porta-balão médio de 46,4±25,0 minutos. A estratégia fármaco-invasiva foi realizada em 20,0...

Patient willingness to undergo a two‐week free trial of a telemedicine service for coronary artery disease after coronary intervention: A mixed‐methods study

“…Telemedicine service interventions are emerging as an effective alternative model for improving secondary prevention of CAD. Most previous studies have focused on applied telemedicine services for cardiovascular diseases, such as ECG analysis of ST‐segment elevation myocardial infarction, wherein in‐hospital mortality reduced and the percentage of patients with door‐to‐balloon time lower than 60 min increased (Matsuda et al, ). In addition, results indicated that telemedicine monitoring in patients with repeat percutaneous coronary intervention or cardioversion for atrial fibrillation is more effective in identifying cardiac arrhythmia (Morguet, Kühnelt, Kallel, Rauch, & Schultheiss, ); Furthermore, when telemedicine services are provided, there is a reduction in hospital admission rate, length of stay and mortality in patients with chronic heart failure and higher quality of life scores (Lin et al, ; Wakefield et al, ).…”

“…Telemedicine service interventions are emerging as an effective alternative model for improving secondary prevention of CAD. Most previous studies have focused on applied telemedicine services for cardiovascular diseases, such as ECG analysis of ST-segment elevation myocardial infarction, wherein in-hospital mortality reduced and the percentage of patients with door-toballoon time lower than 60 min increased (Matsuda et al, 2018).…”

Results of an infarction care telemedicine program

“…Mortality due to STEMI in the in-hospital period was 8.3%, characterizing a significant reduction when compared to the mortality rates in the public service, which reached 26.1% 11 and 15.3%, 10 in 2009 and 2010, respectively. In the region studied the rate is estimated to be even higher, because of difficult access to thrombolysis − a fundamental approach which should be guaranteed.…”

“…Nonetheless, it is important to point out that the said service only had one large spoke facilitating allocation to the transport service. 10 The mean door-balloon time at the hub was 54.3±37.7 minutes, with a median of 46 minutes; however, not considering the reclassified patients as evolved infarction, it was 51±31.3 minutes with a median of 44 minutes. Such values are closed to the means of a similar study, 10 but based on literature, 9 there is still space for improvements, especially in the communication between transport teams and hubs teams, optimizing the cath labs, avoiding idleness, and making access of infarcted patients easier.…”

“…In the year 2000, it corresponded to 16.2%, in 2005 to 16.1%, and in 2010, to 15.3%. [10][11][12] However, we are still very distant from the North American reality, where mortality varied between 5% and 6% in 2009. 1 Based on the rationale we describe, the Latin America Telemedicine Infarct Network (LATIN) program was implemented in the city of Aparecida de Goiânia, in the metropolitan region of Goiânia, located in the state of Goiás, which has only one cath lab service.…”