Improvement in Cardiovascular Outcomes Using Telemedicine to Support Medical Decision in Acute Coronary Syndrome: Experience of Prehospital Public Emergency Care Units in Brazil

Abstract

Background: Cardiovascular diseases are the leading cause of mortality and disability in Brazil and worldwide. Among them, acute coronary syndrome (ACS) stands out as an acute event requiring early diagnosis and intervention, which are decisive factors in the prognosis of these patients. Telehealth, through telediagnosis and cardiology teleconsultation, has emerged as a valuable tool for supporting early diagnosis and appropriate management of ACS cases in a country of continental dimensions and health care access disparities. Methods: A cardiological best-practices program implemented in partnership with the Brazilian Ministry of Health and a private tertiary hospital provided 24/7 tele-electrocardiogram (ECG) interpretation and cardiology teleconsultation support. The program included more than 300 public prehospital emergency care units distributed in 26 Brazilian states. Data from 13,311 eligible patients were analyzed between January 2021 and December 2023. Outcomes such as discharge, hospital transfer, antiplatelet therapy use, and mortality were compared between patients who did and did not receive teleconsultation using both mean differences and Propensity Score Matching models. Results: Among 13,311 patients eligible for teleconsultation with an ECG performed between January 1, 2021, and December 31, 2023, 7,184 had complex arrhythmias (3,854 with success teleconsultation and 3,330 failure), and 6,127 had ST-segment elevation myocardial infarction (STEMI) cases (2,907 with success teleconsultation and 3,220 failure). Analysis indicates that teleconsulting was associated with a reduction in the mortality rate for STEMI in patients with contact when compared with those without contact (X% vs. Y%; p = 0.019). There is also evidence of a lower mortality rate for complex arrhythmias and total eligible patients (STEMI plus complex arrhythmias). Conclusions: Integration of tele-electrocardiography and remote cardiology teleconsultation in prehospital emergency care significantly improves key clinical outcomes for ACS and arrhythmias. This model demonstrates the value of telemedicine to enhance access to specialist care and reduce geographic disparities in cardiovascular emergency treatment.

Keywords: acute coronary syndrome; telecardiology; teleconsultation; telehealth.