AsistIAM: Innovating the Acute Coronary Syndrome Approach in Primary Care Settings

Early management of acute coronary syndrome (ACS) is critical. Clinical guidelines are more consistently implemented in high-complexity hospitals; however, in rural and primary care settings multiple barriers limit timely diagnosis and treatment. This study aimed to develop and evaluate the usability of a mobile application designed to assist primary care physicians in the diagnostic approach and initial management of ACS.

A mHealth tool named AsistIAM was developed with five modules: electrocardiogram pattern, reperfusion strategies, risk assessment, real-time georeferencing, and educational content. Usability was assessed on a 1-7 scale under in both simulated and real-world conditions. In the latter, a before-and-after study was performed with physicians from four rural primary healthcare centers and one referral hospital. In the pre-implementation phase, participants completed a survey identifying barriers to ACS care. After using the app, they complete the same survey to analyze changes.

A total of 18 participants evaluated the app in simulated conditions and 59 in real-world settings. Mean usability scores were high (6.52, in simulation and 6.18 in real-world). The best-rated items were ease of learning, interface satisfaction, and availability of functions. After app implementation, physicians reported improvements in ECG acquisition and interpretation (81.4%-100%), recognition of ST-elevation patterns (25.6%-39.2%), identification of referral centers (88.1%-98.0%), and correct use of fibrinolytics (errors 44.1%-17.6%).

AsistIAM represents an innovative tool to strengthen regional networks, improve ACS management and support timely clinical decision-making. Usability results highlight its intuitive interface, functionality, and practical utility.