Telemedicine Could Be ‘Game Changer’ for Cardiac Care in Developing Countries

MIAMI BEACH, FLA.—Two approaches are narrowing the gap in STEMI care and improving door-to-balloon times worldwide.

Real-time communication between ambulatory personnel and interventional cardiologists is improving transfer time, cutting costs and enhancing survival among patients with possible ACS across the globe. And according to experts, the use of this technology—and telemedicine in general—may reach even farther in both cardiac and non-cardiac spaces.

Telemedicine has the potential to increase early access to health care among patients who may not have otherwise sought care, and to reduce mortality rates in developing countries, said Sameer Mehta, MD, of the University of Miami Miller School of Medicine.

Additionally, telemedicine helps cut costs by reducing needless hospital admissions for symptoms like chest pain, currently the No. 1 presenting complaint in emergency rooms in Brazil and Latin America, Mehta said. He added that almost 70% of these patients are admitted due to a lack of skilled physicians and cardiologists, resulting in the misuse of scarce resources.

In Chile, the rearrangement of the public health system has led to a new law (AUGE) that ensures medical care for all. As a result, documented cases of thrombolysis, primary PCI, angiography, rescue PCI and delayed PCI all have increased.

In response, an acute MI (AMI) protocol has also been established, recommending an ECG within 30 minutes for all suspected AMI cases, regardless of location. As a result, global mortality for AMI has decreased from 12% to 8.6%  based on 2008 data. 

According to Mehta, telemedicine makes ECG technology available in ambulances and helicopters, and its use in the pre-hospital setting is imperative.

Testing CodeHeart

Gabriel L. Sardi, MD, of the division of cardiology at Washington Hospital Center in Washington, D.C., agreed, adding that he and colleagues at his institution have developed a telecommunication software application called “CodeHeart” (CHap), which has improved the time between the initial call and patient arrival to a PCI-capable institution.

CHap allows the interventional cardiologist on-call and the referring physician to have two-way communication in real-time via voice and video. The communication occurs over a secured network that is compliant with existing HIPAA restrictions and can perform on multiple platforms, including cellular video-phone, tablet, desktop computer or laptop. Additionally, the application allows for web-based storage, as well as archiving and retrieval capabilities.

Between March 14, 2011, when CHap was employed, and March 31, 2012, 470 STEMI system activations occurred, Sardi reported. Of 83 activations that occurred with Chap, 49 patients were determined to have STEMI and of those, 47 underwent PCI. In the  standard activation group during the same time period there were 387 activations of which 193 were STEMI and 178 of those underwent PCI. CHap was associated with improved door-to-balloon time, first call-to-catheterization laboratory arrival and first call-to-balloon time (see Table).

“Telemedicine, particularly in less-developed countries, is going to be a game changer. It’s going to alter the way STEMI care is provided to large segments of populations,” Mehta said.