Author + information
- Sameer Mehta1,
- Roberto Botelho2,
- Francisco Fernandez3,
- Marco Perin4,
- Cesar Dusilek5,
- Rodolfo Cardoso6,
- Juan Carlos Perez Alva7,
- Marco Alcocer-Gamba8,
- Daniel Rodriguez9,
- Isaac Yepes10 and
- Mario Torres11
- 1Lumen Foundation, Miami, Florida, United States
- 2Triangulo Heart Institute, Uberlândia, Minas Gerais, Brazil
- 3ITMS, Santiago, Chile
- 4Hospital Sírio-Libânes / Hospital Santa Marcelina, Sao Paulo, São Paulo, Brazil
- 5Hospital do Rocio, Campo largo, Paraná, Brazil
- 6HSCOR - Hospital do Coração de Duque de Caxias., Coracao, Rio de Janeiro, Brazil
- 7Instituto Cardiovascular de Puebla, Puebla, Puebla, Mexico
- 8Instituto de Corazón de Querétaro, Queretaro, Querétaro, Mexico
- 9Lumen Global, Miami, Florida, United States
- 10Lumen Foundation, plantation, Florida, United States
- 11Lumen Foundation, Lake Worth, Florida, United States
We have previously reported on the role of telemedicine to accurately diagnose AMI and to expand access. Providing early revascularization posed logistic, infrastructure and economic challenges.
Access for millions of patients in Colombia, Brazil and Mexico to critical AMI care was provided by creating a telemedicine network that wirelessly connected expert cardiologists at 3 command sites to 23 hubs and 142 spokes. To urgently treat the screened patients, a STEMI Systems of Care methodology was amalgamated. This employed standardized protocols for thrombolysis, pharmaco-invasive and Primary PCI and for data collection and QA.
365,481 patients were screened, 4,271 STEMI (1.1%) diagnosed and 1,833 (54%) urgently treated (91% Primary PCI). D2N times (17 min) were encouraging and D2B time (45 min) were fortuitously low as most PCI centers are small and ED Bypass is easy. However, Door in Door Out (DIDO) times remain stubbornly long at 167 min. Telemedicine systems have become efficient (TTD -Time to Telemedicine Diagnosis 5.4 min); accurate (98%); and cost-effective ($3/diagnosis, $287/STEMI process). LATIN constraint is large number of diagnosed AMI patients not reperfused - reasons include delayed presentation, lack of ICU beds, and insurance denials.
Telemedicine + STEMI Systems of Care hugely expands access. Telemedicine is an extremely powerful screening tool for large populations in remote regions. LATIN remains challenged by delayed presentation, payment issues and lack of beds.
OTHER: Public Health Issues