title: Real-time, two-way interaction during ST-segment elevation myocardial infarction management improves door-to-balloon times.
abstract: OBJECTIVE
  The study aimed to determine if utilization of the CodeHeart application (CHap) reduces door-to-balloon (DTB) times of ST-segment elevation myocardial infarction (STEMI) patients.
  
  
  BACKGROUND
  A pre-hospital electrocardiogram improves the management of patients with STEMI. Current telecommunication systems do not permit real-time interaction with the initial care providers. Our institution developed a novel telecommunications system based on a software application that permits real-time, two-way video and voice interaction over a secured network.
  
  
  METHODS
  All STEMI system activations after implementation of the CHap were prospectively entered into a database. Consecutive CHap activations were compared to routine activations as controls, during the same time period.
  
  
  RESULTS
  A total of 470 STEMI system activations occurred; CHap was used in 83 cases (17.7%). DTB time was reduced by the use of CHap when compared to controls (CHap 103 minutes, 95% CI [87.0-118.3] vs. standard 149 minutes, 95% CI [134.0-164.8], p<0.0001), as was first call-to-balloon time (CHap 70 minutes, 95% CI [60.8-79.5] vs. standard 92 minutes, 95% CI [85.8-98.9], p=0.0002). The percentage of 'true positive' catheterization laboratory activations was nominally higher with the use of CHap, although this did not reach statistical significance [CHap 47/83 (56.6%) vs. routine 178/387 (45.9%), p=0.103].
  
  
  CONCLUSIONS
  The implementation of a two-way telecommunications system allowing real-time interactions between interventional cardiologists and referring practitioners improves overall DTB time. In addition, it has the potential to decrease the frequency of false activations, thereby improving the cost efficiency of a network's STEMI system.
authors.affiliation: Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Gabriel L
authors.initials: GL
authors.lastname: Sardi
authors.affiliation: Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Joshua P
authors.initials: JP
authors.lastname: Loh
authors.affiliation: Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Torguson
authors.affiliation: Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Lowell F
authors.initials: LF
authors.lastname: Satler
authors.affiliation: Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC. Electronic address: ron.waksman@medstar.net.
authors.forename: Ron
authors.initials: R
authors.lastname: Waksman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation / Q000379:methods; D004562:Electrocardiography / Q000295:instrumentation / Q000379:methods; D004636:Emergency Service, Hospital / Q000191:economics; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy; D013685:Telecommunications / Q000191:economics / Q000295:instrumentation; D013997:Time Factors
keywords: Door-to-balloon time; Percutaneous coronary intervention; ST-segment elevation myocardial infarction; Telecommunications