A Mobile Application for STEMI Care Optimization in a Multicenter Health System
Annapoorna KiniAndriy VengrenyukDerek PinedaYuliya VengrenyukAmit HoodaJoseph SweenyGregory SerraoUmesh GidwaniKevin ChasonBeth OliverJonathan NoverMark Dela CruzMatthew BaiUgo A. EzenkweleJonathan MurphyNeelima NadellaDavid PowerAtul KukarBernadette SpringerAmrita GupteIsha RanadiveNitin BarmanVishal KapurSahil KheraJeffrey BanderMichael RedlenerCatrina CropanoSamin SharmaGeorge Dangas
Why the study?
Interhospital transfer logistics and fragmented coordination among care team members may cause delays in treating STEMI patients, motivating evaluation of a mobile application designed to streamline activation and transfer coordination across a multicenter health system.
Does implementation of the STEMIcathAID mobile application reduce door-to-device (D2D) and door-in-door-out (DIDO) times compared with the traditional workflow in a multicenter STEMI care system?
Key Points
- To evaluate the impact of implementing a mobile care coordination application (STEMIcathAID) on treatment and transfer times in a multicenter healthcare system.
- Observational implementation study comparing STEMI activations managed with a mobile application versus traditional workflow across two interfacility transfer routes and one local PCI-capable route.
- Evaluated composite door-to-device (D2D) time and combined transfer pathway door-in-door-out (DIDO) time as primary endpoints.
- Composite D2D time decreased from 92 min (IQR: 63–110) to 71 min (IQR: 60–85; Hodges-Lehmann reduction: 16 min; 95% CI: 8–24; P < 0.001), with benchmark attainment rising from 84.9% (79/93) to 100% (123/123; P < 0.001).
- Combined transfer pathway DIDO decreased from 57.5 min (IQR: 48.3–70.8) to 46.0 min (IQR: 39.5–57.5; Hodges-Lehmann reduction: 12 min; 95% CI: 6–19; P < 0.001), with DIDO ≤45 min rates increasing from 20.4% (11/54) to 46.0% (29/63; P = 0.006).
- D2D and DIDO metrics improved across both interhospital transfer pathways, whereas the local PCI-capable pathway showed no significant improvement.
Study Design
Type
Observational
Multicenter
Yes
Structured PICO
Does implementation of the STEMIcathAID mobile application reduce door-to-device (D2D) and door-in-door-out (DIDO) times compared with the traditional workflow in a multicenter STEMI care system?
P
Population
Patients with STEMI activations across 2 interfacility transfer routes and 1 PCI-capable local pathway in a multicenter health system.
E
Exposure
STEMIcathAID secure mobile application (App) to streamline STEMI activation, transfer coordination, and allow time-stamp data capture
C
Comparator
Traditional STEMI activation and transfer workflow
O
Outcome
Composite door-to-device (D2D) time and combined transfer pathway door-in-door-out (DIDO) timesurrogate
Main Result
Effect estimate: Hodges-Lehmann reduction 16 min (95% CI 8-24)
Absolute Event Rate: 71% vs 92%
p-value: p=<0.001
Implementing a dedicated mobile coordination application significantly reduces interhospital transfer door-in-door-out and overall door-to-device times for STEMI patients, markedly improving attainment of guideline-recommended reperfusion benchmarks.
Limitations
- Observational design
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
““These findings support the feasibility of implementing a standardized, role-based digital workflow across multiple STEMI transfer pathways,” said Annapoorna Subhash Kini, MBBS, FACC; George D. Dangas, MD, PhD, MACC, et al.”
Implication
Digital workflow was associated with shorter STEMI D2D times; leaves open need for outcome trials before system-wide adoption.
Abstract
Background Interhospital transfer logistics and fragmented coordination among care team members may cause delays in treating ST-segment elevation myocardial infarction (STEMI) patients. We developed a secure mobile application, STEMIcathAID (App), to streamline STEMI activation, transfer coordination, and allow time-stamp data capture. Objectives We aimed to assess the effect of App implementation on time measures in a multicenter health care system. Methods We conducted an observational comparison of STEMI activations managed through the App vs the traditional workflow across 2 interfacility transfer routes (pathways 1 and 2), and 1 percutaneous coronary intervention–capable local pathway. The primary analyses were the composite door-to-device (D2D) and combined transfer pathway door-in-door-out (DIDO) comparisons, reported as median (IQR). Results Composite D2D time decreased from 92 min (IQR: 63-110) to 71 min (IQR: 60-85; Hodges-Lehmann reduction: 16 min; 95% CI: 8-24; P < 0.001). Combined transfer pathway DIDO decreased from 57.5 min (IQR: 48.3-70.8) to 46.0 min (IQR: 39.5-57.5; Hodges-Lehmann reduction: 12 min; 95% CI: 6-19; P < 0.001). D2D and DIDO improved in both interhospital transfer pathways, whereas the local pathway showed no significant improvement. D2D target attainment according to pathway-specific registry benchmarks improved from 84.9% (79/93) to 100% (123/123; P < 0.001). The proportion of transfer cases achieving DIDO ≤45 min increased from 20.4% (11/54) to 46.0% (29/63; P = 0.006). Conclusions In this observational multicenter implementation study, App-managed STEMI activations were associated with shorter transfer-related time metrics and higher attainment of guideline-relevant time thresholds across 2 interfacility pathways.
Discussion
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Cite This Study
Kini et al. (2026) conducted an observational in ST-segment elevation myocardial infarction (STEMI). STEMIcathAID mobile application (App) vs. Traditional workflow was evaluated on Composite door-to-device (D2D) time and combined transfer pathway door-in-door-out (DIDO) time (Hodges-Lehmann reduction 16 min, 95% CI 8-24, p=<0.001).