Abstract 12786: Wireless Transmission of a Prehospital Electrocardiogram Can be Cost Effective for Patients with ST-Elevation Myocardial Infarction
Introduction: The time benefits associated with integrated prehospital diagnostics and in-hospital care for patients with ST-elevation myocardial infarction (STEMI) are well established. However, the absence of comparative cost models for these systems was identified by the AHA as a barrier to care guideline adherence.
Hypothesis: Wireless transmission of a prehospital electrocardiogram (ECG) from ambulance to an interventional cardiologist is an economically attractive alternative to standard ambulance transport or patient self-transport to an emergency department (ED).
Methods: We compared pre-intervention cost-of-care and time-to-treatment for patients with STEMI arriving for interventional catheterization via self-transport, paramedics, or paramedics who transmit prehospital ECGs to the interventionalist allowing for bypass of the ED. We utilized publicly available cost and time data to develop a health economic model for implementing an ECG transmission system in Durham County, NC (population of 256,500, two hospitals, 10 ambulances, transporting 43 patients with STEMI/year). We assumed interventionalists were available for 80% of patients and reduced availability to 50% in sensitivity analyses.
Results: Prehospital ECG transmission was, on average, a dominant treatment strategy (lower cost and lower onset-to-treatment time) vs. standard paramedic transport at volumes >31 patients per year. The added cost of wireless prehospital ECG transmission was <$10 per minute of pre-intervention time saved vs. self-transport. When immediate interventionalist availability was reduced to 50% of patients, prehospital ECG transmission remained economically attracitve (Table 1).
Conclusions: In communities with adequate patient volume, cardiologist on-site availability and paramedic coverage, prehospital ECG transmission is cost effective for patients with STEMI.
- © 2010 by American Heart Association, Inc.