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Telemedicine to improve outcomes for patients with acute myocardial infarction
  1. Nichole Bosson1,2
  1. 1 Los Angeles County EMS Agency, Santa Fe Springs, California, USA
  2. 2 Los Angeles County Harbor-UCLA Medical Center, Torrance, California, USA
  1. Correspondence to Dr Nichole Bosson, Los Angeles County EMS Agency, Santa Fe Springs, CA 90670, USA; nbosson{at}dhs.lacounty.gov

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The use of telemedicine, allowing for the transfer of clinical information and remote delivery of healthcare services using telecommunications technology, is rapidly expanding. Telemedicine capabilities are increasingly available between providers at healthcare centres, and between hospital and emergency medical services (EMS), extending the physician’s reach into the prehospital realm without leaving the hospital. The use of telemedicine to transfer data from the field to the hospital and/or to facilitate communication between the physician and EMS providers is typically focused on reducing the time to treatment, with the ultimate goal of improving patient outcomes. Time-sensitive conditions, such as acute myocardial infarction (AMI) and stroke, have been a primary focus given the perceived potential for benefit.

In their Heart paper, Marcolino et al report the results of a systematic review and meta-analysis evaluating the impact of telemedicine interventions on door-to-balloon (D2B) time, in-hospital mortality, and 30-day and long-term mortality in patients with AMI1. The authors found a relative risk of 0.63 (95% CI 0.55 to 0.72), resulting in a number needed to treat of 29 for the primary outcome of in-hospital mortality. This result was based on moderate-quality evidence from 17 observational studies, in 10 of which patients were treated with percutaneous coronary intervention (PCI) and the other 7 with thrombolysis. They report a similar reduction in D2B times (process outcome) and long-term mortality (patient-centred outcome). However, the quality of evidence was very poor, with large heterogeneity observed in the effect on D2B time and very few studies evaluating long-term outcomes.

In the meta-analysis by Marcolino et al, ECG transmission was the main intervention, with or without teleconsultation, in all of the 35 studies included. Further, 31 …

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