Telehealth strategy improves STEMI care in Latin America
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A telehealth strategy implemented in four countries in Latin America was associated with improvements in optimal treatment of STEMI and time to diagnosis, according to the LATIN study presented at the virtual Society for Cardiovascular Angiography and Interventions Scientific Sessions.
“In the COVID era, as we are learning how to use telemedicine, we can see what we have been doing with telemedicine for the last 11 years: management of heart attack coverage of a population of 100 million in Latin America,” Sameer Mehta, MD, MBA, FACC, chairman of the Lumen Foundation, course director of Lumen Global, co-chair of the Global Lumen Organization for Women, global STEMI director of ITMS Telemedicine in Sao Paulo and founder of Cardionomous AI, said during a press conference.
The Latin America Telemedicine Infarct Network (LATIN) began in 2013 to cover more than 100 million people in remote areas of Argentina, Brazil, Colombia and Mexico. The network included a hub-and-spoke platform in which patients who presented to 313 smaller centers (“spokes”) in remote locations — some of which did not even have a physician, much less a cardiologist, on-site — were triaged via ECG analysis by telemedicine experts at one of three locations, and if necessary were transferred to one of 47 larger centers (“hubs”) with PCI capability, Mehta said during the press conference.
“This was created to expand as much as possible into the poorest segments of the countries,” he said. “In some cases, the spokes were located as far as 300 miles away from the hubs. It was at the spokes where we realized we needed to triage the patients effectively. There were all sorts of challenges and regional variability.”
Between 2013 and 2019, telemedicine experts screened 780,234 patients and diagnosed 1.1% of them with STEMI, Mehta said. Of those deemed to have STEMI, 46.1% were transferred to a hub, and of those who went to a hub, 78% were reperfused with PCI, he said.
“For the majority of patients, we did not even need to choose exactly whether the patient was going to have thrombolysis, pharmacoinvasive management or primary PCI,” Mehta said during the press conference. “Most of the time, depending on location and distance from the spoke to the hub, that was already determined.”
The rate of primary PCI was much higher than traditional rates, he said. “In these four countries, before we started, almost 85% of patients were not reperfused or thrombolytic therapy was used,” he said.
Time to telemedicine diagnosis was 3.5 minutes, mean door-to-balloon time was 48 minutes and the STEMI mortality rate was 5.2%, according to the researchers.
“It used to take us 11 minutes to get a time to telemedicine diagnosis,” Mehta said during the press conference.
“I think so many diseases which are time-sensitive, including heart attack and stroke, can be monitored, navigated and remote-controlled through the possibilities of telemedicine,” he said. – by Erik Swain
Reference:
Mehta S, et al. Featured Clinical Research. Presented at: Society for Cardiovascular Angiography and Interventions Scientific Sessions; May 14-16, 2020 (virtual meeting).
Disclosures: The study was supported by an educational grant from the Medtronic Foundation. Mehta reports no relevant financial disclosures.
Perspective
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M. Chadi Alraies, MD, FACC
The most important take-home message is that telemedicine helps diagnose and manage patients with STEMI within the reasonable door-to-balloon time before the COVID-19 pandemic in rural areas of Latin America.
Since the COVID-19 pandemic occurred and stay-at-home orders have been in place, we noticed a substantial decrease in STEMI and ACS volume to the ED and cath lab. It is of interest now to utilize telemedicine for patients with heart disease who require timely management but want to avoid coming to health care centers due to the fear of getting infected with the virus that causes COVID-19.
It would be of interest to see a study comparing telemedicine to the conventional way of managing patients presenting with ACS. If telemedicine shows efficacy and safety comparable to the conventional way of managing STEMI, then this will offload emergency visits and possibly decrease door-to-balloon times.
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Mehta S, et al. Featured Clinical Research. Presented at: Society for Cardiovascular Angiography and Interventions Scientific Sessions; May 14-16, 2020 (virtual meeting).
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