P1742Is time to telemedicine diagnosis (TTD) analogous to door to balloon time?

Background

Telemedicine is a powerful, cost-efficient, and scalable tool for population-based AMI management. Traditional metrics of D2N, D2B do not gauge telemedicine effectiveness. We explored the utility of TTD in 784,947-screened patients within the Latin America Telemedicine Infarct Network (LATIN).

Purpose

To evaluate the competence of TTD as an efficiency indicator in telemedicine.

Methods

LATIN employed a spoke-hub strategy to expand access in Brazil, Colombia, Mexico, and Argentina. Small clinics (spokes) in remote areas were strategically connected to PCI-capable facilities (hubs). Experts at 4 remote locations provided urgent EKG diagnosis via tele-consultation, additionally, they triggered ambulance dispatch and implementation of guidelines-based protocols. Investing in updated telemedicine technology provided a system-wide TTD reduction.

Results

714,450 patients were screened for AMI at 350 LATIN centers (Brazil 143, Colombia 118, Mexico 82, Argentina 7). Within our territories 8,448 (1.08%) patients were diagnosed as STEMI; 3,911 (46.3%) were urgently reperfused, of those 3,049 (78%) underwent Primary PCI. TTD was 3 min, demonstrating 98.9% tele-accuracy. D2B was 51 min; in-hospital mortality 5.2%. We encountered a linear correlation between D2B and TTD. The latter was, also, inversely related to the number of screened patients - both associations are favorable for LATIN.

Conclusions

TTD is an important indicator of telemedicine efficiency. LATIN will continue to explore this value's strength and other important associations.

P6142LATIN telemedicine - expanded umbrella of cost-effective ami coverage for 100 million people

Background

AMI is a unique entity where the immediate diagnosis can be made by a single test, the EKG. Despite this matchless attribute of easy diagnosis, developing (and some developed) countries lack resources and efficient pathways for urgent and reliable diagnosis of AMI. With Latin Telemedicine Infarct Network (LATIN), we have previously presented Telemedicine as a pragmatic solution for urgent and accurate diagnosis of AMI. In this work, we reveal pathways of scalable population-based AMI management models.

Purpose

To utilize telemedicine as a foundation pillar for creating cost-effective and global models of AMI management.

Methods

LATIN pilot tested the hypothesis of remote guidance of AMI management and expanded access by creating a hub and spoke, STEMI systems of care that exploited regional resources. A highly efficient, web-based, cloud-computing prototype was developed and scrupulously monitored with a new metric of time to telemedicine diagnosis (TTD). STEMI systems of care were created to efficiently triage the diagnosed patients for being treated with thrombolysis, pharmaco-invasive management or Primary PCI. This stratagem had enormous provincial variability and was constrained mainly by ambulance structure. Telemedicine and IT costs were forced lower and enabled a cost-effective process to hugely provide access to 100 million patients located in poorer regions of Colombia, Brazil, Mexico, and Argentina. Education and training have formed the mantra for LATIN and stakeholder development, and ambulance systems development has remained immutable goals.

Results

Almost 800,000 patients were successfully screening through LATIN with a cost for accurate STEMI diagnosis of < $3, a tele accuracy that exceeded 95% and with TTD <4 minutes. A total of 8,440 (1.1%) of patients were diagnosed with AMI in this manner and 3,924 (46.5%) urgently reperfused, mainly with Primary PCI (3,048, 77.8%). D2B times have been lowered now to 51 minutes but this is fortuitous, as several PCI-capable facilities are small, and direct transfer to the catheterization laboratory is easy. Door in and Door out times and transport times remain high as a large number of patients are denied by insurance and other payers for treatment. Overall, mortality is 5.2%.

Conclusions

Global financial and philanthropic institutions should contemplate models analogous to LATIN for saving the lives of millions of poor patients in developing countries from AMI.

P575Merging technologies to provide Mexico an innovative nationwide AMI management network

Background

“Cόdigo Infarto”, the vast patient-centric, app-based, educational crusade of the Mexican Society of Interventional Cardiology (SOCIME) has been combined with the Latin America Telemedicine Infarct Network (LATIN) to create a comprehensive, national AMI program for Mexico.

Purpose

To demonstrate the benefits of amalgamating educational initiatives of national cardiology societies with a global telemedicine program for improving AMI management.

Methods

“Cόdigo Infarto” App connects patients to a network of several hundred cardiologists and 250 Primary PCI-capable labs. LATIN provides the partnership with its robust telemedicine platform, a hub-spoke strategy that supports patient's access to appropriate medical management. Remotely located experts, in Colombia, provide urgent EKG diagnosis via tele-consultation to the entire LATIN Mexico network. They activate ambulance dispatch and implement guideline-based protocols.

Results

Numerous “Cόdigo Infarto” sites have incorporated LATIN to provide a simple and accelerated management of AMI patients. Currently, the partnership (7 hubs, 78 spokes) has screened 19,886 patients. A total of 359 STEMI cases (1.8%) have been diagnosed; 118 patients (33%) were urgently reperfused, Primary PCI was performed in 74% of the latter cases. D2B time was 41 min. Reasons for the lack of treatment include delayed presentation, lack of ICU beds and insurance denials. Currently, these constraints are being methodically probed. Updated results will be available at time of presentation.

Conclusions

The synergy of the AMI initiative for Mexico provides a template for similar initiatives in developing countries.

Familial transmission of a serious disease--producing group A streptococcus clone: case reports and review

Invasive group A streptococcus (GAS) infections are emerging diseases; however, person-to-person transmission of invasive GAS producing life-threatening infection has been observed rarely. We report a small intrafamilial cluster of life-threatening GAS infections. A previously healthy 47-year-old father developed necrotizing fasciitis of the neck. Two days later, his 16-year-old daughter developed streptococcal angina, pneumonia, and pleural empyema. Both patients had signs of streptococcal toxic shock syndrome. Pulsed field gel electrophoresis revealed that the M6 strains of GAS isolated from the father and daughter had identical patterns. Cases of person-to-person transmission of invasive GAS infection reported in the literature are also reviewed.