Utilization of Telefax System for Early Detection, Interpretation and Management of Acute ST-Elevation Myocardial Infarction: An Initial Experience from Rural Punjab Telecardiology Rapid Access Project.

ABSTRACT

OBJECTIVES: The aim of this study was to assess the feasibility, safety and efficacy of telecardiology-guided initiation of therapy and management of acute coronary syndrome at primary care hospitals before the transfer of the patient to a tertiary care center. METHODS: This study covered 25 of 41 patients diagnosed with acute coronary syndrome at the Kharar Civil Hospital over a period of 15 months. These 25 patients (group A) had ST-elevation myocardial infarction. The remaining 16, with non- ST-elevation acute coronary syndrome, were excluded from the study. The group A patients were thrombolyzed at the Kharar Civil Hospital under telecardiology guidance (transmission of the electrocardiograms by fax to the coronary care unit of the PGIMER, where they were analyzed by a cardiologist). The patients were later sent to the PGIMER for further treatment. The group A patients were compared with two control groups (B and C) of 25 patients each with similar problems. The group B patients were referred for thrombolysis to the emergency ward of the PGIMER from local hospitals (situated at a distance of about 15 km), after acute myocardial infarction had been confirmed by electrocardiograms. The group C patients had come directly to the PGIMER emergency ward for thrombolysis. The patients in all groups were evaluated in terms of door-to-needle time saved, improvement in left ventricular systolic function and adverse events during hospitalization, as well as at three months' follow-up. RESULTS: For patients in group A, the mean door-to-needle time was 67.08 +/- 18.21 minutes. It was 121.8 +/- 48.71 minutes for those in group B and 22.68 +/- 9.24 minutes for those in group C. Thus, the differences among the groups were significant (p < 0.0001). Complications were rare and none occurred during transfer from the Kharar Civil Hospital to the PGIMER. The ejection fraction of all the patients showed an improvement between the time of admission and at three months' follow-up (p < 0.0001). CONCLUSIONS: Utilizing telecardiology advances, district hospital physicians, in collaboration with cardiologists at the tertiary center, can provide adequate standard diagnosis at the pre-coronary care unit level and also provide adequate therapy for acute myocardial infarction. Early administration of streptokinase in the civil hospital brought about a significant reduction in door-to-needle time and considerable improvement in left ventricular function.