Abstract 15532: Telemedicine to Guide AMI Management - Introducing a New Metric for Evaluating Efficiency

IntroductionTelemedicine protocols can guide population-based AMI by teleconsulting the entire STEMI process and procedure. We have previously reported on the application of telemedicine to reduce disparities of AMI care between developed and developing countries. We have continued to explore optimal metrics to evaluate the efficiency of telemedicine.HypothesisTTD is an efficiency indicator in a telemedicine-based, patient care program and it is directly related to door-to-balloon (D2B) time.MethodsLatin America Telemedicine Infarct Network, LATIN, is a population-based AMI management program with a hub and spoke strategy in Brazil, Colombia, Chile, Argentina, and Chile. Experts at remote locations provide urgent ECG diagnosis and trigger ambulance dispatch and implementation of guidelines-based protocols. Time to Telemedicine Diagnosis (TTD) compiles the time for 5 critical telemedicine milestones1) Transmission of the ECG using cloud computing; 2) Filtering and processing at command site; 3) Expert interpretation; 4) Generation of results in a HIPAA compatible format; 5) Transmission of the report to remote site.ResultsLATIN screened 832,324 patients; 8,928 were diagnosed as STEMI; 3,859 (43.2%) underwent PCI. TTD was 3.5 min. D2B was 48 min; in-hospital mortality 5.2%. A linear correlation between D2B and TTD was observed. TTD was also inversely related to the number of screened patients.ConclusionsTTD is a sensitive measure of telemedicine performance. Like D2B times, achieving short TTD should be a goal for telemedicine-guided AMI management.