PMID- 35720760
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220716
IS  - 2692-4366 (Electronic)
IS  - 2692-4366 (Linking)
VI  - 2
IP  - 1
DP  - 2021
TI  - Chest Pain Network with Support of Telemedicine: Impact on Reperfusion Therapy 
      and Clinical Outcomes After 8 Years of Experience.
PG  - 284-292
LID - 10.1089/tmr.2021.0033 [doi]
AB  - Background: Different approaches of evaluation by cardiologists using 
      telemedicine have the potential of improving care of patients with ST elevation 
      myocardial infarction (STEMI). Objective: To compare the use of pharmacoinvasive 
      strategy and associated clinical outcomes (heart failure [HF] and mortality) 
      among patients with STEMI before and after a program of telemedicine and also 
      according to the level of support by telemedicine. Methods: A chest pain network 
      with the support of a cardiologist through telemedicine was implemented in 2012 
      in 22 emergency departments without a local cardiac catheterization laboratory. 
      Initially (phase 1 of telemedicine), the decision to discuss the case with the 
      cardiologist was based on the judgment of the emergency physician. At the end of 
      2018, the use of telemedicine was modified and a dedicated cardiologist was 
      available continuously to discuss systematically all suspected cases (phase 2 of 
      telemedicine). The use of fibrinolytics and the rates of HF and in-hospital 
      mortality were compared among three different periods: pretelemedicine (2011), 
      and phase 1 and phase 2 of the telemedicine program. Results: We evaluated 1034 
      STEMI patients and after comparing the three phases, we did not find significant 
      differences regarding age, gender, and comorbidities. The use of fibrinolytics 
      before transferring STEMI patients to a percutaneous coronary intervention center 
      (pharmacoinvasive strategy) increased after telemedicine implementation (38% vs. 
      65.2%; p < 0.01), which was associated with a lower rate of HF (23.9% vs. 14.4%; 
      p = 0.01) and death (7.9% vs. 4.0%; p = 0.05). The in-hospital mortality was 
      lower in phase 2 with systematic evaluation by telemedicine compared with 
      pretelemedicine (7.9% vs. 3.3%; p = 0.04). Conclusion: The implementation of a 
      systematic and organized chest pain protocol, including telemedicine support, was 
      associated with a significant increase in the use of pharmacoinvasive strategy 
      and better clinical patient outcomes in patients with STEMI. Our findings provide 
      important insights on how to improve the management of this high-risk population, 
      reducing the gap between evidence and clinical practice.
CI  - (c) United Health Group Brazil, 2021; Published by Mary Ann Liebert, Inc.
FAU - de Barros E Silva, Pedro Gabriel Melo
AU  - de Barros E Silva PGM
AUID- ORCID: 0000-0003-1940-4470
AD  - Hospital Samaritano Paulista, Sao Paulo, Brazil.
AD  - Americas Servicos Medicos, Sao Paulo, Brazil.
AD  - Centro Universitario Sao Camilo, Sao Paulo, Brazil.
FAU - Macedo, Thiago Andrade
AU  - Macedo TA
AD  - Hospital Samaritano Paulista, Sao Paulo, Brazil.
AD  - Centro Universitario Sao Camilo, Sao Paulo, Brazil.
FAU - Lopes, Renato D
AU  - Lopes RD
AD  - Hospital Samaritano Paulista, Sao Paulo, Brazil.
AD  - Americas Servicos Medicos, Sao Paulo, Brazil.
AD  - Duke Clinical Research Institute, Duke University Medical Center, Durham, North 
      Carolina, USA.
FAU - Okada, Mariana Y
AU  - Okada MY
AD  - Hospital Samaritano Paulista, Sao Paulo, Brazil.
FAU - Frigini, Tiago
AU  - Frigini T
AD  - Americas Servicos Medicos, Sao Paulo, Brazil.
FAU - Roveri, Patricia O
AU  - Roveri PO
AD  - Hospital Samaritano Paulista, Sao Paulo, Brazil.
FAU - Balada, Rodrigo
AU  - Balada R
AD  - Centro Universitario Sao Camilo, Sao Paulo, Brazil.
FAU - de Macedo, Lucas Silva
AU  - de Macedo LS
AD  - Centro Universitario Sao Camilo, Sao Paulo, Brazil.
FAU - Furlan, Valter
AU  - Furlan V
AD  - Hospital Samaritano Paulista, Sao Paulo, Brazil.
AD  - Americas Servicos Medicos, Sao Paulo, Brazil.
LA  - eng
PT  - Journal Article
DEP - 20211222
PL  - United States
TA  - Telemed Rep
JT  - Telemedicine reports
JID - 101773797
PMC - PMC8812289
OTO - NOTNLM
OT  - ST-segment elevation myocardial infarction
OT  - acute coronary syndrome
OT  - telemedicine
COIS- P.G.M.B.S. reports grants and personal fees from Pfizer, Bayer, and Roche 
      Diagnostics outside the submitted work. R.D.L. reports grants from Amgen; 
      personal fees from Bayer, Boehringer Ingelheim, and Portola; and grants and 
      personal fees from Bristol Myers Squibb, Glaxo Smith Kline, Pfizer, and 
      Sanofi-Aventis outside the submitted work. All other authors have no disclosures 
      to report.
EDAT- 2022/06/21 06:00
MHDA- 2022/06/21 06:01
PMCR- 2021/12/22
CRDT- 2022/06/20 03:46
PHST- 2021/11/20 00:00 [accepted]
PHST- 2022/06/20 03:46 [entrez]
PHST- 2022/06/21 06:00 [pubmed]
PHST- 2022/06/21 06:01 [medline]
PHST- 2021/12/22 00:00 [pmc-release]
AID - 10.1089/tmr.2021.0033 [pii]
AID - 10.1089/tmr.2021.0033 [doi]
PST - epublish
SO  - Telemed Rep. 2021 Dec 22;2(1):284-292. doi: 10.1089/tmr.2021.0033. eCollection 
      2021.