Prehospital ECG transmission results in shorter door-to-wire time for STEMI patients in a remote mountainous region

Brunetti, Natale Daniele; Dell'Anno, Annarita; Martone, Alessandro; Natale, Emanuela; Rizzon, Brian; Cillo, Ottavio Di; Russo, Angelo

doi:10.1016/j.ajem.2019.04.046

Cited by 16 publications

(15 citation statements)

References 15 publications

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“…We analyzed data from three telemedicine dispatch centers, one located in Genoa, serving private clients (pharmacies, general practitioners [ 10 ]), another located in Brescia (serving pharmacies), and another located in Bari, serving regional public STEMI network and emergency medical service in Apulia (4 million inhabitants) [ 11 ]. Demographic data (age, gender) and principal electrocardiogram diagnosis were collected and analyzed.…”

Section: Methodsmentioning

confidence: 99%

Impact of 2020 SARS-CoV-2 outbreak on telemedicine management of cardiovascular disease in Italy

et al. 2020

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The Covid-19 pandemic affected large part of Italy since February 2020; we, therefore, aimed to assess the impact of 2020 SARS-CoV-2 outbreak on telemedicine management of cardiovascular disease (CVD) in Italy. We analyzed data from three telemedicine dispatch centers, one located in Genoa, serving private clients (pharmacies, general practitioners), one in Brescia, serving pharmacies, and one in Bari, serving regional public STEMI network and emergency medical service in Apulia (4 million inhabitants). Demographic data and principal electrocardiogram diagnosis were collected and analyzed. Records from the time interval March 1, 2020 and April 1, 2020 were compared with the corresponding period in 2019. The comparative analysis of data shows a 54% reduction of telemedicine electrocardiogram transmission in Genoa telemedicine center (from 364 to 166), 68% in Brescia (from 5.745 to 1.905), 24% in Bari (from 15.825 to 11.716); relative reduction according to electrocardiogram diagnosis was 38% for acute coronary syndrome, 40% for other acute CVD in Genoa center, 24% for acute coronary syndrome, and 38% for other acute CVD in Bari. Male/female ratio remained substantially unchanged. A dramatic reduction of telemedicine access for CVD was observed during Covid-19 outbreak in March 2020 in Italy. The reduction was substantially consistent for all electrocardiogram findings, ACS, other acute CVD and normal.

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Section: Methodsmentioning

confidence: 99%

Impact of 2020 SARS-CoV-2 outbreak on telemedicine management of cardiovascular disease in Italy

et al. 2020

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“…Finally, 12 studies were investigated for qualitative analysis, comprising eight non-randomised controlled studies and four quasi-experimental studies. In the quantitative analysis, four studies were excluded, as three did not report DTB time or mortality rates 17–19 and the other was incapable of performing percutaneous coronary intervention (PCI). 4…”

Section: Resultsmentioning

confidence: 99%

Prehospital tele-electrocardiographic triage improves the management of acute coronary syndrome in rural populations: A systematic review and meta-analysis

2020

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Introduction Acute coronary syndrome (ACS) patients residing in rural areas are predisposed to higher risk of poor outcomes due to substantial delays in disease management, emphasising the importance of emerging telecardiology technologies in delivering emergency services in such settings. This meta-analysis aimed to investigate the impacts of prehospital telecardiology strategies on the clinical outcomes of rural ACS patients. Methods A literature search was performed of articles published up to April 2020 through six databases. Included studies were assessed for bias risk using the ROBINS-I tool, and a random-effects model was utilised to estimate effect sizes. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Results Twelve studies with a total of 3989 patients were included in this review. Prehospital telecardiology in the form of tele-electrocardiography (tele-ECG) enabled prompt diagnosis and triage, resulting in a decreased door-to-balloon (DTB) time (mean difference = –25.53 minutes, 95% confidence interval (CI) –36.08 to –14.97 minutes; I2 = 98%), as well as lower in-hospital mortality (odds ratio (OR) = 0.57, 95% CI 0.36–0.92) and long-term mortality (OR = 0.52, 95% CI 0.39–0.69) rates, both with negligible heterogeneity ( I2 = 0%). GRADE assessment yielded very low to moderate certainty of evidence. Conclusion Prehospital tele-ECG appeared to be an effective and worthwhile approach in the management of rural ACS patients, as shown by moderate quality evidence on lower long-term mortality. Given the uncertainties of the evidence quality on DTB time and in-hospital mortality, future studies with a higher quality of evidence are required to confirm our findings.

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“…The second finding of the present study is the usefulness of telemedicine at reducing pre- and post-hospital delay times during the pandemic. Telemedicine has been demonstrated to be effective at reducing delay times in patients with STEMI [ 35 – 38 ], but all of the conclusions made by these studies were based on the normal functioning of health care facilities, when there were no screening protocols in place. To our knowledge, the present study is the first to explore the efficacy of telemedicine for reducing delay times in patients with STEMI during the COVID-19 pandemic.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Clinical Outcomes in Patients with ST Elevation Myocardial Infarction with Percutaneous Coronary Intervention and the Use of a Telemedicine App Before and After the COVID-19 Pandemic at a Center in Beijing, China, from August 2019 to March 2020

Jiang

Meng

et al. 2020

Med Sci Monit

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Prehospital ECG transmission results in shorter door-to-wire time for STEMI patients in a remote mountainous region

Cited by 16 publications

References 15 publications

Impact of 2020 SARS-CoV-2 outbreak on telemedicine management of cardiovascular disease in Italy

Impact of 2020 SARS-CoV-2 outbreak on telemedicine management of cardiovascular disease in Italy

Prehospital tele-electrocardiographic triage improves the management of acute coronary syndrome in rural populations: A systematic review and meta-analysis

Comparison of Clinical Outcomes in Patients with ST Elevation Myocardial Infarction with Percutaneous Coronary Intervention and the Use of a Telemedicine App Before and After the COVID-19 Pandemic at a Center in Beijing, China, from August 2019 to March 2020

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