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

Abstract

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.

The Effectiveness of Mobile Cloud 12-Lead Electrocardiogram Transmission System in Patients with ST-Segment Elevation Myocardial Infarction

“…However, we reported FMCTB time was 80 (63-92) min in this study, even in the Conventional group. Similarly, door-to-balloon time and door-to-catheter laboratory time of prehospital-ECG group in the previous study were 68 (52-83) min and 27 (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36) min. However, those of the Conventional group in this study were 59 (38-67) min and 24 (15-41) min, espectively.…”

“…Prehospital 12-lead ECG improved the transport time and 30-day mortality for both STEMI and non-STEMI patients [24]. Prehospital tele-ECG shortened the door-to-balloon time and reduced in-hospital mortality in rural acute coronary syndrome patients [25]. Nowadays, machine learning-based prediction of prehospital 12-lead ECG has been reported [26].…”

Telecardiology in Rural Practice: Global Trends

“…Thus, tele-consultation could be a characteristic of telecardiology specific to rural practice. Lazarus G. et al [ 37 ] already reported that prehospital tele-ECG appeared to be an effective and worthwhile approach in the management of rural ACS patients on a systematic review because of decreased door-to-balloon time on catheter intervention. Moreover, this paper concluded that it may reduce the cardiovascular in-hospital and long-term mortality.…”

Telemedicine-enabled ambulances and mobile stroke units for prehospital stroke management

“…However, the “mini-MSU” model brings telemedicine to the ambulance, and with appropriate cooperation and integration across specialties, this model has already been shown to deliver prehospital expertise in stroke, other neurological emergencies, neonatal emergencies, cardiac arrest, or acute coronary syndrome (ACS), acute respiratory distress, and trauma. 28,29 Furthermore, fully embracing the field utilization of telemedicine may lead to fewer unnecessary Emergency Department visits, shifting care away from acute setting into the outpatient setting and lowering the overall cost of healthcare. 26 The emergence of 5G fast networks and global connectivity will continue to “bridging the gap” between highly concentrated areas with specialists/subspecialists to patients in need especially coming from rural and underserved areas of the globe.…”