Impact of Chest Pain Protocol with Access to Telemedicine on Implementation of Pharmacoinvasive Strategy in a Private Hospital Network

BACKGROUND

Brazilian registries have shown a gap between evidence-based therapies and real treatments. We aim to compare the use of the pharmacoinvasive strategy and mortality in patients with ST elevation myocardial infarction (STEMI) transferred pre- and post-chest pain protocol with access to telemedicine (CPPT) in a private hospital network.

MATERIALS AND METHODS

A CPPT was implemented in 22 private emergency departments in 2012. Emergency physicians and nurses of all facilities were trained to disseminate the information to comply with a chest pain protocol focusing on reperfusion therapy (pharmacoinvasive strategy) for STEMI. To conduct clinical discussions using telemedicine, a cardiologist from a reference hospital in cardiology (RHC) was available 24 h/day, 7 days/week. Using the database of all consecutive admissions, we compared the data of patients with STEMI transferred to the RHC in 2011 (pre-CPPT) and 2013-2014 (post-CPPT).

RESULTS

We included 376 patients (113 pre-CPPT and 263 post-CPPT) with STEMI. All patients admitted in the RHC were transferred from the 22 emergency departments. Comparing pre-CPPT and post-CPPT, we did not find differences regarding age, gender, hypertension, dyslipidemia, diabetes, smoking, previous myocardial infarction, or Killip classification. However, the use of CPPT was associated with a greater use of pharmacoinvasive strategy (55.8% versus 38%; p = 0.002) and a trend toward lower in-hospital mortality (3% versus 8%; p = 0.06).

CONCLUSIONS

The implementation of a CPPT was associated with a significant increase in the use of pharmacoinvasive strategy in patients with STEMI and a trend toward reduced in-hospital mortality in a private hospital network.

Telemedicine in extreme conditions: supporting the Martin Strel Amazon Swim Expedition

Slovenian Martin Strel, the Guinness world record holder in ultra marathon swimming, recently set a new world record by swimming the entire Amazon River. Over a 66-day period beginning in Atalaya, Peru, he swam to the Atlantic Ocean at Belém, Brazil. This record-breaking swim was part of the Amazon Swim Expedition. This entire mission was supported by a comprehensive medical team, the Amazon Virtual Medical Team (AVMT), which provided medical support using telemedicine. The AVMT, a multinational volunteer group of specialists, physicians, and telemedicine experts, provided medical support 24/7 in some of the most remote, dangerous, basin. The AVMT was directed basin. The AVMT was directed by Dr. Rifat Latifi and expedition team physician, Dr. Mateja de Leonni Stanonik, who was aboard the boat during the entire expedition. The expedition provided a unique opportunity to promote telemedicine and e-health in over 17 communities in the Amazon basin.