Original ContributionTime-to-reperfusion in STEMI undergoing interhospital transfer using smartphone and WhatsApp messenger☆,☆☆
Introduction
Total ischemic time affects mortality in those patients presenting with ST-segment elevation myocardial infarction (STEMI) [1]. Current guidelines have recommended that the interval between arrival at the hospital and restoration of coronary flow to the ischemic myocardium be 90 minutes or less as a system goal [2]. Primary percutaneous coronary intervention (pPCI) seems to be superior to fibrinolytic therapy in achieving myocardial reperfusion if performed within 90 minutes [3]. Rural STEMI care networks may be particularly disadvantaged in achieving this benchmark for patient-, transport-, and hospital-related delays.
For communication between the emergency physician (EP) and the interventional cardiologist in STEMI, the most frequently used method is a verbal report via telephones. Telephone communication can be rapid but not objective and precise. More recently, photographs taken by smartphone were transferred to another smartphone [4]. WhatsApp (WhatsApp Inc, Mountain View, CA) is an increasingly popular mobile messaging application available on all smartphone platforms.
WhatsApp triage has been advocated as a means to identify patients with STEMI earlier by an EP, activate the cardiac catheterization laboratory (CCL) earlier, and minimize interhospital-based delays to improve total door-to-balloon (D2B) time. This study aims to evaluate, for the first time, the use of WhatsApp for facilitating communication between the EP in a rural hospital without PCI capability and the interventional cardiologist at the PCI hospital to achieve guideline recommendations.
Section snippets
Methods
Between January 2015 and May 2015, a total of 114 patients with suspected STEMI were prospectively enrolled from a rural hospital without PCI capability and subsequently underwent pPCI at our institution. The health care network covers an area of 11,977 km2 and provides care for a primary population of 750,000 people. On average, 650 to 700 patients with STEMI are referred each year to the our center for primary PCI, and approximately 60% of these patients are referred directly from the rural
Results
We identified 108 patients with STEMI treated during the study period. Fifty-three patients underwent WhatsApp triage (group 1), with 55 patients available as a contemporary control, not receiving triage but with activation of the CCL through the EP (group 2). The baseline characteristics are detailed in the Table. A total of 114 patients had been evaluated, but 5 of the patients were diagnosed with non-STEMI on hospital arrival in group 2. Percutaneous coronary intervention was not performed
Discussion
The development of smartphones opened up a new opportunity to integrate mobile technology in daily clinical practice [6], [7]. In addition, the development of new applications facilitated communication among users by improving the taking, storage, and transmission of images [7], [8]. The release of WhatsApp Messenger proved even more useful. This is the first study of WhatsApp triage and early activation by an EP. We observed shorter D2B times and a greater proportion of patients achieving
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