A Mobile Application for STEMI Care Optimization in a Multicenter Health System

Interhospital transfer logistics and fragmented coordination among care team members may cause delays in treating ST-segment elevation myocardial infarction (STEMI) patients. We developed a secure mobile application, STEMIcathAID (App), to streamline STEMI activation, transfer coordination, and allow time-stamp data capture.

We aimed to assess the effect of App implementation on time measures in a multicenter health care system.

We conducted an observational comparison of STEMI activations managed through the App vs the traditional workflow across 2 interfacility transfer routes (pathways 1 and 2), and 1 percutaneous coronary intervention-capable local pathway. The primary analyses were the composite door-to-device (D2D) and combined transfer pathway door-in-door-out (DIDO) comparisons, reported as median (IQR).

Composite D2D time decreased from 92 min (IQR: 63-110) to 71 min (IQR: 60-85; Hodges-Lehmann reduction: 16 min; 95% CI: 8-24; P < 0.001). Combined transfer pathway DIDO decreased from 57.5 min (IQR: 48.3-70.8) to 46.0 min (IQR: 39.5-57.5; Hodges-Lehmann reduction: 12 min; 95% CI: 6-19; P < 0.001). D2D and DIDO improved in both interhospital transfer pathways, whereas the local pathway showed no significant improvement. D2D target attainment according to pathway-specific registry benchmarks improved from 84.9% (79/93) to 100% (123/123; P < 0.001). The proportion of transfer cases achieving DIDO ≤45 min increased from 20.4% (11/54) to 46.0% (29/63; P = 0.006).

In this observational multicenter implementation study, App-managed STEMI activations were associated with shorter transfer-related time metrics and higher attainment of guideline-relevant time thresholds across 2 interfacility pathways.