Abstract 24024: Utilizing Telemedicine to Construct Population-Based STEMI Systems of care in Developing Countries

Abstract

Background: Major disparities exist between developed and developing countries in the outcomes of patients presenting with Acute Myocardial Infarction (AMI). Telemedicine has emerged as a powerful, cost-efficient, and scalable tool. Whether telemedicine can improve AMI results remains unclear. Methods: We incorporated a hub and spoke strategy for Latin America Telemedicine Infarct Network (LATIN) to expand access to care in regions in Brazil, Colombia, and Mexico that lacked AMI care. Small clinics and primary care health centers in remote areas (spokes) were strategically connected to hubs that could perform 24/7 primary PCI. Experts at 3 central sites in Uberlandia, Sao Paulo, and Bogota, provided urgent EKG diagnosis and tele-consultation for the entire LATIN network by triggering ambulance dispatch and implementing standardized AMI protocols. Results: A total of 257 LATIN centers (Brazil 95, Colombia 113, Mexico 49) were networked using similar telemedicine protocols. In Colombia, LATIN coverage was established to cover 31% of the nation’s 48 million population. With this expanded geographic reach, 4.694 (1.2%) of the 401,095 screened patients were diagnosed as having STEMI. A total of 2,041 (43.5%) STEMI were urgently reperfused. Primary PCI was performed in the majority of patients - 1,578 (77.3%) that were referred for urgent perfusion. The major reasons for non-treatment included insurance denials, lack of ICU beds and chest pain >12 hours. Time to Telemedicine Diagnosis (TTD) was 5.1 minutes, and tele-ECG accuracy was 98%. D2B time for the cohort was 53 minutes, but chest pain to treatment time was >6 hours. Overall, in-hospital mortality was 5.8%. Conclusions: LATIN demonstrates the feasibility of creating a population based and telemedicine-guided AMI management strategy that can hugely expand access to reperfusion strategies. Telemedicine has important public health implications as a global approach to urgent AMI care in developing countries.