Impact of telemedicine in STEMI care system: A five-year experience from Tamil Nadu, India

Abstract

Background & objectives: Timely reperfusion reduces mortality in ST-segment elevation myocardial infarction (STEMI). Telemedicine and social media have been shown to improve STEMI care in community settings as reported previously. We established a government-sponsored STEMI care system in the State of Tamil Nadu with a goal of enhancing guideline-directed revascularisation (GDR) in STEMI. This study aimed to improve GDR by networking non-percutaneous coronary intervention (PCI)-capable hospitals with PCI capable hospitals in a hub-and-spoke model and implementing telemedicine through social media groups. Methods: Eighteen Government medical college hospitals were provided cardiac catheterisation laboratories and linked to 188 Taluk and non-PCI capable Government hospitals forming 18 STEMI clusters. Telemedicine guidance on STEMI management was provided through WhatsApp groups created for each cluster. Cumulative daily data on the number of STEMIs, the revascularisation provided, and mortality were collected through free online web forms. Annual cumulative data on STEMI volumes and GDR were analysed. Results: A total of 71,907 individuals were treated for STEMI from 2019 to 2023. A 67 per cent annual increase in the total individuals treated for STEMI was observed. The proportion of individuals receiving pharmaco-invasive therapy (PIT) increased from 7.9 to 31.7 per cent. There was a 68 per cent increase in the individuals receiving primary PCI. The number of individuals without GDR decreased by 20 per cent. There was a 6.7-fold rise in the individuals referred from spoke to hub hospitals for catheter-based revascularization. Overall mortality showed a marginal decrease from 8.7 to 8.4 per cent. Interpretation & conclusions: Findings of this study suggest that a government-sponsored STEMI care system in a hub-and-spoke model, guided by telemedicine through social media groups will improve GDR in STEMI care in developing nations.