Smartphone-based Tele-ECG support for primary care physicians significantly reduced the median hospital-to-aspirin time for acute coronary syndrome compared to standard care (0.7 vs 3.5 h; p<0.0001).
Observational (n=334)
Yes
Does smartphone-based Tele-ECG support reduce hospital-to-aspirin time in patients with acute coronary syndrome presenting to primary care physicians?
Smartphone-based Tele-ECG support for primary care physicians significantly reduces hospital-to-aspirin time for patients with acute coronary syndrome, offering an effective, low-cost strategy.
Absolute Event Rate: 0.7% vs 3.5%
p-value: p=<0.0001
Background The Himachal Pradesh state acute coronary syndrome registry recorded a median delay of 13 h between the time of onset of pain to the time of making the diagnosis and giving treatment for acute coronary syndrome. We conducted a pilot study on providing 24-h tele-electrocardiography (Tele-ECG) services in the district Kangra of Himachal Pradesh, with the aim to reduce the time taken for diagnosis of acute coronary syndrome. Methods The intervention group for the study included eight rural community health centres, each with one to three primary care physicians, who were all unskilled in electrocardiogram interpretation. We provided them with 24-h Tele-ECG support. The primary care physicians used their smartphones to transmit the electrocardiogram image to the command centre, which was then read by the skilled specialist physicians in our medical college hospital and the report sent back within five minutes of having received the electrocardiogram. Antiplatelets were given by the primary care physician to patients diagnosed with acute coronary syndrome, who was then transported to the medical college hospital. The urban sub-divisional hospitals ( n = 6) formed the control group for the study. These hospitals had five to fifteen unskilled primary care physicians and one to two skilled specialist physicians; no intervention was done in this group. A pilot was run from February 2015-January 2016. Results We received 819 Tele-ECG consultations within the intervention group; 157 cases of acute coronary syndrome were confirmed and transferred to our medical college hospital facility. Similarly, we admitted 177 cases of acute coronary syndrome at the medical college hospital, who were first attended to by the primary care physician in the control group. Aspirin was administered to 91% and 58% of patients with acute coronary syndrome in the intervention and the control groups, respectively ( p < 0.0001). The median hospital-to-aspirin time (h) in the intervention and the control groups was 0.7 ± 1.45 h and 3.5 ± 10 h, respectively ( p < 0.0001). In the intervention group, 72% of the ST elevation myocardial infarction patients were diagnosed within 12 h by the primary care physician using Tele-ECG support. Interpretation and conclusions Smartphone-based Tele-ECG support for primary care physicians reduced the hospital-to-aspirin time in acute coronary syndrome significantly ( p < 0.0001). This is an effective low cost strategy and is easily replicable anywhere in the world.
Chauhan et al. (Thu,) conducted a observational in Acute coronary syndrome (n=334). Smartphone-based tele-electrocardiography (Tele-ECG) support vs. Standard care without Tele-ECG support was evaluated on Median hospital-to-aspirin time (hours) (p=<0.0001). Smartphone-based Tele-ECG support for primary care physicians significantly reduced the median hospital-to-aspirin time for acute coronary syndrome compared to standard care (0.7 vs 3.5 h; p<0.0001).