Smartphone-based tele-electrocardiography support for primary care physicians reduces the pain-to-treatment time in acute coronary syndrome
Smartphone-based tele-electrocardiography support for primary care physicians reduces the pain-to-treatment time in acute coronary syndrome
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DOI：
10.1177/1357633x17719395
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发表时间：
2018-09-01
影响因子：
4.7
通讯作者：
Pandey, Kumar S.
中科院分区：
文献类型：
--
作者：
Chauhan, Vivek;Negi, Prakash C.;Pandey, Kumar S.
背景资料：喜马偕尔邦急性冠状动脉综合征登记处记录了疼痛发作到诊断和治疗急性冠状动脉综合征之间的中位延迟时间为13小时。我们进行了一项试点研究，提供24小时远程心电图（远程心电图）在喜马偕尔邦康格拉区的服务，目的是减少诊断急性冠脉syndrome.Methods所需的时间：干预组的研究包括8个农村社区卫生中心，每个有一到三个初级保健医生，谁都不熟练的心电图解释。我们为他们提供24小时远程心电图支持。初级保健医生使用他们的智能手机将心电图图像传输到指挥中心，然后由我们医学院医院的熟练专家医生阅读，并在收到心电图后五分钟内发回报告。由初级保健医生给诊断为急性冠状动脉综合征的患者服用抗血小板药物，然后将患者送往医学院医院。城市二级医院（n = 6）作为研究的对照组。这些医院有5到15名不熟练的初级保健医生和1到2名熟练的专科医生;在这组中没有进行干预。2015年2月至2016年1月进行了试点。结果：干预组共收到819例远程心电图咨询; 157例急性冠脉综合征患者被确诊并转移到我院。同样，我们在医学院医院收治了177例急性冠状动脉综合征患者，这些患者首先由对照组的初级保健医生治疗。在干预组和对照组中，分别有91%和58%的急性冠脉综合征患者服用阿司匹林（p < 0.0001）。干预组和对照组的中位住院至服用阿司匹林时间（h）分别为0.7 ± 1.45 h和3.5 ± 10 h（p
Background: The Himachal Pradesh state acute coronary syndrome registry recorded a median delay of 13 h between the time of onset of pain to the time of making the diagnosis and giving treatment for acute coronary syndrome. We conducted a pilot study on providing 24-h tele-electrocardiography (Tele-ECG) services in the district Kangra of Himachal Pradesh, with the aim to reduce the time taken for diagnosis of acute coronary syndrome.Methods: The intervention group for the study included eight rural community health centres, each with one to three primary care physicians, who were all unskilled in electrocardiogram interpretation. We provided them with 24-h Tele-ECG support. The primary care physicians used their smartphones to transmit the electrocardiogram image to the command centre, which was then read by the skilled specialist physicians in our medical college hospital and the report sent back within five minutes of having received the electrocardiogram. Antiplatelets were given by the primary care physician to patients diagnosed with acute coronary syndrome, who was then transported to the medical college hospital. The urban sub-divisional hospitals (n = 6) formed the control group for the study. These hospitals had five to fifteen unskilled primary care physicians and one to two skilled specialist physicians; no intervention was done in this group. A pilot was run from February 2015-January 2016.Results: We received 819 Tele-ECG consultations within the intervention group; 157 cases of acute coronary syndrome were confirmed and transferred to our medical college hospital facility. Similarly, we admitted 177 cases of acute coronary syndrome at the medical college hospital, who were first attended to by the primary care physician in the control group. Aspirin was administered to 91% and 58% of patients with acute coronary syndrome in the intervention and the control groups, respectively (p < 0.0001). The median hospital-to-aspirin time (h) in the intervention and the control groups was 0.7 +/- 1.45 h and 3.5 +/- 10 h, respectively (p