P4568Utilizing telemedicine platforms to construct population-based AMI management - Results from half a million patient encounters in Latin America Telemedicine Infarct Network (LATIN)

Abstract

Background: We have previously reported on utilizing telemedicine to screen large populations and optimize management of the diagnosed AMI patients within indigenous STEMI networks. Purpose(s): To demonstrate the results of the scalability of this Telemedicine + STEMI Network model and offer this prototype as a template for creating population-based AMI management in developing countries. Method(s): As shown in the attached figure, rapid and massive scalability of the LATIN model was achieved in Brazil, Colombia and Mexico.We attribute this rapid deployment to perfecting an efficient telemedicine-guided platform that enabled huge expansion of access within the LATIN hub and spoke model. All 51 LATIN centers in Mexico were tele-guided through a command center located in Colombia, demonstrating the impact and reach of telemedicine. We estimate LATIN to provide approximately 70 million patients with a telemedicine umbrella of AMI coverage. Result(s): Already 522,800 screening encounters have yielded 6,250 STEMI patients (1.2%) and prevented expensive transfer, hospitalization and unnecessary procedures on hundreds of thousands of patients. Total savings from LATIN are estimated >$200 million. Of the 6,250 diagnosed STEMI patients, 2,687 (43%) were urgently revascularized, mostly with Primary PCI (72%), and with short D2B times (49 min) and low in-hospital mortality (4.8%). Telemedicine efficiency seems to have peaked with low system wide Time to Telemedicine Diagnosis (TTD) of 3.8 minutes. However, Door In Door Out (DIDO) times (107 min) and Transfer Time (60 min) remain stubbornly prolonged and system deficits (insurance denials, lack of ICU beds and delayed presentation) do not allow early revascularization of a large proportion of diagnosed patients. Conclusion(s): Telemedicine is a robust modality for creating population-based AMI programs, particularly in resource-constrained developing countries. Scalability can enormously expand access and provide cost-effective models. estimated >$200 million. Of the 6,250 diagnosed STEMI patients, 2,687 (43%) were urgently revascularized, mostly with Primary PCI (72%), and with short D2B times (49 min) and low in-hospital mortality (4.8%). Telemedicine efficiency seems to have peaked with low system wide Time to Telemedicine Diagnosis (TTD) of 3.8 minutes. However, Door In Door Out (DIDO) times (107 min) and Transfer Time (60 min) remain stubbornly prolonged and system deficits (insurance denials, lack of ICU beds and delayed presentation) do not allow early revascularization of a large proportion of diagnosed patients.