title: Impact of Chest Pain Protocol with Access to Telemedicine on Implementation of Pharmacoinvasive Strategy in a Private Hospital Network.
abstract: Brazilian registries have shown a gap between evidence-based therapies and real treatments. We aim to compare the use of the pharmacoinvasive strategy and mortality in patients with ST elevation myocardial infarction (STEMI) transferred pre- and post-chest pain protocol with access to telemedicine (CPPT) in a private hospital network.
  
  
  
  A CPPT was implemented in 22 private emergency departments in 2012. Emergency physicians and nurses of all facilities were trained to disseminate the information to comply with a chest pain protocol focusing on reperfusion therapy (pharmacoinvasive strategy) for STEMI. To conduct clinical discussions using telemedicine, a cardiologist from a reference hospital in cardiology (RHC) was available 24 h/day, 7 days/week. Using the database of all consecutive admissions, we compared the data of patients with STEMI transferred to the RHC in 2011 (pre-CPPT) and 2013-2014 (post-CPPT).
  
  
  
  We included 376 patients (113 pre-CPPT and 263 post-CPPT) with STEMI. All patients admitted in the RHC were transferred from the 22 emergency departments. Comparing pre-CPPT and post-CPPT, we did not find differences regarding age, gender, hypertension, dyslipidemia, diabetes, smoking, previous myocardial infarction, or Killip classification. However, the use of CPPT was associated with a greater use of pharmacoinvasive strategy (55.8% versus 38%; p = 0.002) and a trend toward lower in-hospital mortality (3% versus 8%; p = 0.06).
  
  
  
  The implementation of a CPPT was associated with a significant increase in the use of pharmacoinvasive strategy in patients with STEMI and a trend toward reduced in-hospital mortality in a private hospital network.
authors.affiliation: Emergency Department, Hospital TotalCor , São Paulo, Brazil .
authors.forename: Thiago Andrade
authors.initials: TA
authors.lastname: Macedo
authors.affiliation: Emergency Department, Hospital TotalCor , São Paulo, Brazil .
authors.forename: Pedro Gabriel Melo
authors.initials: PG
authors.lastname: de Barros E Silva
authors.affiliation: Emergency Department, Hospital TotalCor , São Paulo, Brazil .
authors.forename: Sheila Aparecida
authors.initials: SA
authors.lastname: Simões
authors.affiliation: Emergency Department, Hospital TotalCor , São Paulo, Brazil .
authors.forename: Mariana Yumi
authors.initials: MY
authors.lastname: Okada
authors.affiliation: Emergency Department, Hospital TotalCor , São Paulo, Brazil .
authors.forename: José Carlos Teixeira
authors.initials: JC
authors.lastname: Garcia
authors.affiliation: Emergency Department, Hospital TotalCor , São Paulo, Brazil .
authors.forename: Marcio Campos
authors.initials: MC
authors.lastname: Sampaio
authors.affiliation: Emergency Department, Hospital TotalCor , São Paulo, Brazil .
authors.forename: Roberto Nery
authors.initials: RN
authors.lastname: Dantas
authors.affiliation: Emergency Department, Hospital TotalCor , São Paulo, Brazil .
authors.forename: Roger Pereira
authors.initials: RP
authors.lastname: Oliveira
authors.affiliation: Emergency Department, Hospital TotalCor , São Paulo, Brazil .
authors.forename: Liliane Gomes
authors.initials: LG
authors.lastname: Rocha
authors.affiliation: Emergency Department, Hospital TotalCor , São Paulo, Brazil .
authors.forename: Bernardo Baptista
authors.initials: BB
authors.lastname: da Cunha Lopes
authors.affiliation: Emergency Department, Hospital TotalCor , São Paulo, Brazil .
authors.forename: Tiago
authors.initials: T
authors.lastname: Frigini
authors.affiliation: Emergency Department, Hospital TotalCor , São Paulo, Brazil .
authors.forename: Valter
authors.initials: V
authors.lastname: Furlan
mesh_terms: D000368:Aged; D001938:Brazil; D002985:Clinical Protocols / Q000592:standards*; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D016304:Hospitals, Private / Q000458:organization & administration* / Q000592:standards; D006801:Humans; D033181:Information Dissemination / Q000379:methods*; D007318:Inservice Training; D008297:Male; D008875:Middle Aged; D000072657:ST Elevation Myocardial Infarction / Q000628:therapy*; D017216:Telemedicine / Q000458:organization & administration* / Q000592:standards
keywords: chest pain protocol; myocardial infarction; telemedicine