Telemedicine Network Program for Reperfusion of Myocardial Infarction

Alejandro Silberstein, Maximiliano de Abreu, Javier Mariani, Diego Kyle, Gabriel González Villamonte, Ricardo Sarmiento, Carlos D. Tajer

Abstract


Background: Early management of myocardial infarction in the area of public health requires the integration of specific programsfor the coordination of healthcare services.Objective: The aim of this study was to evaluate the impact on delay times and reperfusion rate of a comprehensive programfor the reperfusion of myocardial infarction in a hospital network of the Southern Greater Buenos Aires.Methods: The network consists of six low-mid-complexity hospitals and a third-level referral center with 24-hour cath-lab.Stage 1 of the program (2009-2010) evaluated the existing barriers to reperfusion; Stage 2 (2011-2013) implemented theprogressive incorporation of improvements and Stage 3 assessed the program (2013-2014) complemented with fellows in eachhospital. Program impact was evaluated by the proportion of patients reperfused and time to its implementation.Results: A total of 432 patients referred from the network were hospitalized with diagnosis of ST-segment elevation myocardialinfarction. Mean age was 56±9 years and 83.3% were men. The proportion of reperfused patients progressively increased:S1 60.7%, S2 69% and S3 78%, p for trend=0.01. Time to reperfusion decreased significantly between S1 and S3, from 120minutes (IQR 55-240) to 90 minutes (IQR 35-150), p=0.04, with a median reduction of 30 minutes in the door-to-balloon anddoor-to-needle times.Conclusions: The application of a program for myocardial reperfusion based on the diagnosis of barriers was associated with28.5% increase in reperfusion, and a significant reduction in the implementation times. This public network model built onalgorithms adapted to local barriers may contribute to improve the care of myocardial infarction in our country.

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Revista argentina de cardiología. ISSN en línea 1850-3748. Argentine journal of cardiology (English ed. Online ISSN 2314-2286) Sociedad Argentina de Cardiología. Azcuénaga 980 (C1115AAD),Ciudad Autónoma de Buenos Aires, República Argentina. Tel. (54 11) 4961-6027/8/9 Fax: 4961-6020 www.sac.org.ar revista@sac.org.ar