title: Time-to-reperfusion in STEMI undergoing interhospital transfer using smartphone and WhatsApp messenger.
abstract: OBJECTIVE
  The objective of this study is to assess the efficacy of WhatsApp application as a communication method among the emergency physician (EP) in a rural hospital without percutaneous coronary intervention (PCI) capability and the interventional cardiologist at a tertiary PCI center.
  
  
  BACKGROUND
  Current guidelines recommend that patients with ST-segment elevation myocardial infarction (STEMI) receive primary PCI within 90 minutes. This door-to-balloon (D2B) time has been difficult to achieve in rural STEMI.
  
  
  RESULTS
  We evaluated 108 patients with STEMI in a rural hospital with emergency department but without PCI capability to determine the impact of WhatsApp triage and activation of the cardiac catheterization laboratory on D2B time. The images were obtained from cases of suspected STEMI using the smartphones by the EP and were sent to the interventional cardiologist via the WhatsApp application (group 1, n=53). The control group included concurrently treated patients with STEMI during the same period but not receiving triage (group 2, n=55). The D2B time was significantly shorter in the intervention group (109±31 vs 130±46 minutes, P<.001) with significant reduction in false STEMI rate as well.
  
  
  CONCLUSIONS
  This study demonstrates that use of WhatsApp triage with activation of the cardiac catheterization laboratory was associated with shorter D2B time and results in a greater proportion of patients achieving guideline recommendations. The method is cheap, quick, and easy to operate.
authors: Department of Cardiology, Evliya Celebi Training and Research Hospital, Kutahya, Turkey. Electronic address: maliastarcioglu@hotmail.com.
authors: Mehmet Ali
authors: MA
authors: Astarcioglu
authors: Department of Cardiology, Evliya Celebi Training and Research Hospital, Kutahya, Turkey.
authors: Taner
authors: T
authors: Sen
authors: Department of Cardiology, Dumlupinar University, Kutahya, Turkey.
authors: Celal
authors: C
authors: Kilit
authors: Department of Cardiology, Mustafa Kalemli State Hospital, Kutahya, Turkey.
authors: Halil Ibrahim
authors: HI
authors: Durmus
authors: Department of Cardiology, Malatya State Hospital, Malatya, Turkey.
authors: Gokhan
authors: G
authors: Gozubuyuk
authors: Department of Cardiology, Kosuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey.
authors: Macit
authors: M
authors: Kalcik
authors: Department of Cardiology, Kafkas University, Kars,Turkey.
authors: Suleyman
authors: S
authors: Karakoyun
authors: Department of Cardiology, Kosuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey.
authors: Mahmut
authors: M
authors: Yesin
authors: Department of Cardiology, Kosuyolu Kartal Heart Training and Research Hospital, Istanbul, Turkey.
authors: Hicaz
authors: H
authors: Zencirkiran Agus
authors: Department of Cardiology, Dumlupinar University, Kutahya, Turkey.
authors: Basri
authors: B
authors: Amasyali
mesh_terms: D005260:Female; D006780:Hospitals, Rural; D006801:Humans; D008297:Male; D008875:Middle Aged; D063731:Mobile Applications; D009203:Myocardial Infarction / Q000628:therapy*; D010360:Patient Transfer / Q000379:methods; D062645:Percutaneous Coronary Intervention / Q000592:standards*; D017410:Practice Guidelines as Topic; D000068997:Smartphone; D013685:Telecommunications / Q000295:instrumentation / Q000592:standards; D061665:Time-to-Treatment / Q000592:standards*; D014218:Triage / Q000379:methods