These remote cardiologists were responsible for triggering ambulance dispatch and initiation of the standardised LATIN protocols.Ĭomprehensive LATIN strategy and standardised protocol. ECGs labelled high-risk for STEMI were prioritised. After processing of those ECGs by technicians (including inputting patient demographics and symptoms), all were read by a LATIN cardiologist. All ECGs that were performed at the spokes were remotely sent to the telemedicine centre.
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Communication software generated automatic alerts from the remote cardiologist to both the hubs and spokes in addition to providing routine feedback. Automatic vectorisation of the ECG with elimination of noise artefacts and incorporation into the medical record was utilised. Telemedicine platforms installed at these sites provided immediate diagnosis, secure user and network interface, compatibility, quality assurance, and database management. Telemedicine was used to transmit a patient’s ECG (performed at a “spoke’) to the cardiologist, and subsequently to allow that cardiologist to diagnose a STEMI and guide the treatment process, all remotely.
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The role of telemedicine was to connect expert cardiologists, at three remote sites, who were working full time for LATIN to diagnose a STEMI on an ECG, and subsequently trigger the LATIN protocol to transport that patient to a hub so that they could undergo a PCI. Three remote telemedicine command centres were established within the programme (Uberlandia and Sao Paulo in Brazil, and Bogota, Colombia), where expert cardiologists provided urgent electrocardiogram (ECG) diagnosis and tele-consultation for the entire network. The spokes were small community health and primary care centres with very limited resources, often having a single primary care physician with limited expertise in managing AMI. The spokes functioned as the point of first medical contact for patients, where a cardiologist was usually not present. Centres with 24/7 PCI capabilities (“hubs”) were identified in each region to perform STEMI interventions for patients referred from smaller clinics or centres (“spokes”). We implemented this protocol in selected regions of Brazil and Colombia, establishing a hub-and-spoke model at each LATIN site. (Figure 1) was created to guide comprehensive AMI management. Using established STEMI guidelines, a standardised Latin America Telemedicine Infarct Network (LATIN) protocol In our present research, we will evaluate further the impact of the said network on STEMI diagnosis, treatment, and outcomes. We have previously reported on a pilot programme that displayed the economic value of a population-based telemedicine-guided STEMI network in a controlled cohort. Telemedicine has also been demonstrated to increase healthcare professionals’ adherence to established therapeutic measures for STEMI, along with a statistically significant reduction in in-hospital, 30-day, and one-year mortalityĨ. The American College of Physicians has made official policy and position recommendations regarding the use of telemedicine due its potential to reduce costs, improve outcomes, and increase access to careħ. Immediate revascularisation in STEMI is the standard of care and a strategy that can be successfully applied to entire populations irrespective of individual socio-economic statusįurthermore, longitudinal studies demonstrate long-term improvements in patient outcomes when guideline-based strategies to reduce door to balloon time (D2B) are systematically adopted to create a STEMI networkĥ 6. Updated STEMI guidelines from the American Heart Association, American College of Cardiology, and the European Society of Cardiology emphasise the need to develop regional systems of care for primary percutaneous coronary intervention (PCI)ġ 2.
Telemedicine is a promising technology for managing ST-elevation myocardial infarction (STEMI), especially in developing countries where care is compromised by lack of resources, delayed patient presentation, and an absence of systems of care.