Author + information
- Sameer Mehta1,
- Samin Sharma2,
- Sanjeev Sharma3,
- Jitendra S. Makkar4,
- Isaac Yepes5,
- Mario Torres6 and
- Daniel Rodriguez7
- 1Lumen Foundation, Miami, Florida, United States
- 2Mount Sinai Health System, New York, New York, United States
- 3Fortis Escorts Hospital, Jaipur, Rajasthan, India
- 4Eternal Heart, Jaipur, Rajasthan, India
- 5Lumen Foundation, plantation, Florida, United States
- 6Lumen Foundation, Lake Worth, Florida, United States
- 7Lumen Global, Miami, Florida, United States
AMI management in India is constrained by lack of infra-structure, ambulance systems and insurance coverage. A STEMI systems of care approach is altogether lacking. As a result, there are considerable delays in presentation and major disparities exist based upon the financial ability to pay.
Rajasthan Heart Attack Treatment (RAHAT) has been indigenously developed to provide cost-effective AMI coverage for the 65 million residents of India’s most populous state, Rajasthan. RAHAT incorporates a standardized, guidelines-based strategy for thrombolysis, pharmaco-invasive management and primary PCI. A hub and spoke strategy massively expands the geographic reach of RAHAT. Using this methodology, as depicted in the attached figure, AMI patients are urgently triaged at the spokes. Primary PCI is the dominant strategy with goals to achieve reperfusion in <90 minutes. Indigenous technology, readily available in India, has been maximally exploited for creating RAHAT. Telemedicine infrastructure includes sophisticated, web-based IT strategies, cloud computing, GPS navigation, IOT, machine learning and EMRI. Cost-effectiveness, an absolute imperative for developing countries, has been diligently instituted at every level of RAHAT
RAHAT is being gradually launched beginning with the capital, Jaipur. All systems are functional and AMI management has begun. Updated results will be presented at TCT. Financial costs have been meticulously determined, and are as follows: Hardware $7,692/hub, $3,076/spoke; process cost $52, procedure cost, including DES, <$1000 and $1 for remote expert diagnosis.
RAHAT is a cost-effective, population-based, AMI initiative, that has exploited India’s IT strength to create a behemoth, telemedicine-fronted, STEMI network. RAHAT serves as a template for other Indian states and for developing countries.
OTHER: Political, International and Societal Issues