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. 2021 Dec 22;2(1):284-292.
doi: 10.1089/tmr.2021.0033. eCollection 2021.

Chest Pain Network with Support of Telemedicine: Impact on Reperfusion Therapy and Clinical Outcomes After 8 Years of Experience

Pedro Gabriel Melo de Barros E Silva  1   2   3 , Thiago Andrade Macedo  1   3 , Renato D Lopes  1   2   4 , Mariana Y Okada  1 , Tiago Frigini  2 , Patricia O Roveri  1 , Rodrigo Balada  3 , Lucas Silva de Macedo  3 , Valter Furlan  1   2
Affiliations

Chest Pain Network with Support of Telemedicine: Impact on Reperfusion Therapy and Clinical Outcomes After 8 Years of Experience

Pedro Gabriel Melo de Barros E Silva et al. Telemed Rep. .

Abstract

Background: Different approaches of evaluation by cardiologists using telemedicine have the potential of improving care of patients with ST elevation myocardial infarction (STEMI). Objective: To compare the use of pharmacoinvasive strategy and associated clinical outcomes (heart failure [HF] and mortality) among patients with STEMI before and after a program of telemedicine and also according to the level of support by telemedicine. Methods: A chest pain network with the support of a cardiologist through telemedicine was implemented in 2012 in 22 emergency departments without a local cardiac catheterization laboratory. Initially (phase 1 of telemedicine), the decision to discuss the case with the cardiologist was based on the judgment of the emergency physician. At the end of 2018, the use of telemedicine was modified and a dedicated cardiologist was available continuously to discuss systematically all suspected cases (phase 2 of telemedicine). The use of fibrinolytics and the rates of HF and in-hospital mortality were compared among three different periods: pretelemedicine (2011), and phase 1 and phase 2 of the telemedicine program. Results: We evaluated 1034 STEMI patients and after comparing the three phases, we did not find significant differences regarding age, gender, and comorbidities. The use of fibrinolytics before transferring STEMI patients to a percutaneous coronary intervention center (pharmacoinvasive strategy) increased after telemedicine implementation (38% vs. 65.2%; p < 0.01), which was associated with a lower rate of HF (23.9% vs. 14.4%; p = 0.01) and death (7.9% vs. 4.0%; p = 0.05). The in-hospital mortality was lower in phase 2 with systematic evaluation by telemedicine compared with pretelemedicine (7.9% vs. 3.3%; p = 0.04). Conclusion: The implementation of a systematic and organized chest pain protocol, including telemedicine support, was associated with a significant increase in the use of pharmacoinvasive strategy and better clinical patient outcomes in patients with STEMI. Our findings provide important insights on how to improve the management of this high-risk population, reducing the gap between evidence and clinical practice.

Keywords: ST-segment elevation myocardial infarction; acute coronary syndrome; telemedicine.

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Conflict of interest statement

P.G.M.B.S. reports grants and personal fees from Pfizer, Bayer, and Roche Diagnostics outside the submitted work. R.D.L. reports grants from Amgen; personal fees from Bayer, Boehringer Ingelheim, and Portola; and grants and personal fees from Bristol Myers Squibb, Glaxo Smith Kline, Pfizer, and Sanofi-Aventis outside the submitted work. All other authors have no disclosures to report.

Figures

FIG. 1.
FIG. 1.
Summary of the telemedicine program (phases 1 and 2).
FIG. 2.
FIG. 2.
In-hospital mortality of STEMI patients during the 8 years of telemedicine program (phases 1 and 2). STEMI, ST elevation myocardial infarction.
See this image and copyright information in PMC

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