Abstract 19441: Novel Telecommunications Software for Two-Way Interaction during ST-Segment Elevation Myocardial Infarction Management Improves Door-to-Balloon Times
Background: A pre-hospital electrocardiogram (ECG) improves the management of patients with ST-segment elevation myocardial infarction (STEMI). Current telecommunication systems do not permit real-time interaction with first responders in the field or with care providers at referring hospitals. Our institution has developed a novel telecommunications system based on a software application that is downloadable to multiple platforms to permit real-time, two-way video and voice interaction over a secured, Health Insurance Portability and Accountability Act (HIPPA) compliant network. Hypothesis: Use of the CodeHeart application (CHap) for patients with possible acute coronary syndrome (ACS) will reduce door-to-balloon (DTB) times of STEMI patients.
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 (03/14/2011 to 12/31/2011). System quality measures were calculated and compared using Student’s t test or the Mann-Whitney U test as appropriate.
Results: A total of 360 STEMI system activations occurred. 62 (17%) employed CHap and 298 (83%) routine channels. DTB times were reduced by the use of CHap when compared to controls (95.3±35’ vs. 154.6±102.4’, p=0.0009) as were first call-to-balloon times (68.9±29.3’ vs. 91.7±40’, p=0.004), which highlights the efficiency of the system for transferred patients. The percentage of catheterization laboratory activations for a true STEMI was higher with the use of CHap, although this trend did not reach statistical significance. [CHap 38/62 (61.3%) vs. routine 148/298 (49.7%), p=0.12].
Conclusion: The implementation of a two-way telecommunications system that allows for real-time interactions between interventional cardiologists and referring practitioners improves overall DTB time and transfer time. In addition, it has the potential to decrease the frequency of false activations, therefore improving cost-efficiency of a network’s STEMI system.
- © 2012 by American Heart Association, Inc.