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Real-time, two-way interaction during ST-segment elevation myocardial infarction management improves door-to-balloon
Gabriel L Sardi1, Joshua P Loh1, Rebecca Torguson1
1Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
Insights
The CodeHeart application (CHap) significantly reduced door-to-balloon times for ST-segment elevation myocardial infarction (STEMI) patients. This novel telecommunication system enhances STEMI care by enabling real-time interaction and potentially reducing false activations.
Area of Science:
- Cardiology
- Medical Informatics
- Health Technology
Background:
- Pre-hospital electrocardiograms are crucial for ST-segment elevation myocardial infarction (STEMI) management.
- Existing telecommunication systems lack real-time interaction capabilities with initial care providers.
- A novel, secure telecommunication application (CodeHeart application - CHap) was developed for real-time, two-way voice and video interaction.
Purpose of the Study:
- To evaluate the impact of the CodeHeart application (CHap) on door-to-balloon (DTB) times in STEMI patients.
- To determine if CHap improves the efficiency of STEMI care delivery.
Main Methods:
- Prospective data collection of all STEMI system activations post-CHap implementation.
- Comparison of consecutive CHap activations against routine activations during the same period.
- Analysis of door-to-balloon times and first call-to-balloon times.
Main Results:
- CHap was utilized in 17.7% of 470 STEMI activations.
- CHap significantly reduced DTB time (103 minutes) compared to standard care (149 minutes, p<0.0001).
- First call-to-balloon time was also reduced with CHap (70 minutes vs. 92 minutes, p=0.0002).
Conclusions:
- Real-time interaction via CHap improves door-to-balloon times for STEMI patients.
- The system shows potential for decreasing false activations, enhancing cost-efficiency.
- Implementation of two-way telecommunication systems is beneficial for STEMI network management.
Objectives:
The study aimed to determine if utilization of the CodeHeart application (CHap) reduces door-to-balloon (DTB) times of ST-segment elevation myocardial infarction (STEMI) patients.
Background:
A pre-hospital electrocardiogram improves the management of patients with STEMI. Current telecommunication systems do not permit real-time interaction with the initial care providers. Our institution developed a novel telecommunications system based on a software application that permits real-time, two-way video and voice interaction over a secured network.
Methods:
All STEMI system activations after implementation of the CHap were prospectively entered into a database. Consecutive CHap activations were compared to routine activations as controls, during the same time period.
Results:
A total of 470 STEMI system activations occurred; CHap was used in 83 cases (17.7%). DTB time was reduced by the use of CHap when compared to controls (CHap 103 minutes, 95% CI [87.0-118.3] vs. standard 149 minutes, 95% CI [134.0-164.8], p<0.0001), as was first call-to-balloon time (CHap 70 minutes, 95% CI [60.8-79.5] vs. standard 92 minutes, 95% CI [85.8-98.9], p=0.0002). The percentage of 'true positive' catheterization laboratory activations was nominally higher with the use of CHap, although this did not reach statistical significance [CHap 47/83 (56.6%) vs. routine 178/387 (45.9%), p=0.103].
Conclusion:
The implementation of a two-way telecommunications system allowing real-time interactions between interventional cardiologists and referring practitioners improves overall DTB time. In addition, it has the potential to decrease the frequency of false activations, thereby improving the cost efficiency of a network's STEMI system.
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