P3408Telemedicine + STEMI systems of care: novel solution to massively expand access to AMI care in developing countries

Abstract

Background: We have previously reported on the role of telemedicine to accurately diagnose AMI and expand access. Providing early revascularization for these patients posed logistic, infrastructure and economic challenges. Purpose: To provide comprehensive and guidelines based AMI management to massive populations in Latin America, we incorporated a ST Elevation Myocardial Elevation (STEMI) Systems of Care strategy to efficient telemedicine triage (Figure 1). Methods: Access for millions of patients in Colombia, Brazil and Mexico to urgent AMI care was provided by creating a telemedicine network that wirelessly connected expert cardiologists at 3 command sites to 88 spokes and 21 hubs. To improve telemedicine triage, a STEMI Systems of Care approach was used. This employed standardized protocols for thrombolysis, pharmaco-invasive management and Primary PCI and for data collection and QA. Results: 225,271 patients were screened, 2514 STEMI (1.1%) diagnosed and 1,301 (52%) urgently revascularized (92% with Primary PCI). Reasons for nontreatment included delayed presentation, lack of ICU beds, and insurance approvals. Door to balloon times continue to trend lower, averaging 78 minutes but chest time to revascularization times remain stubbornly long. Telemedicine systems have become efficient (time to telemedicine diagnosis 5.5 minutes), accurate (98%) and cost-effective ($3/EKG interpretation, $287/STEMI process). Conclusion: Blending telemedicine with STEMI Systems of Care approach hugely expands access. Telemedicine is an extremely powerful screening tool for large populations in remote locations. STEMI systems remain challenged by delayed presentation, payment issues and lack of beds. (Figure Presented).