A novel, groundbreaking trial has examined the viability of telemedicine for remote guidance of a population-based ST-segment elevation myocardial infarction (STEMI) programme reaching more than 100 million patients. The study, presented as late-breaking science during the SCAI 2020 Scientific Sessions Virtual Conference (14–16 May, Eastern Time), indicates that telemedicine transcends boundaries, enabling millions of patients to STEMI care access.
During the study, patients were triaged at spokes that included small clinics and primary healthcare centres in remote locations and transferred to hubs with capability to perform percutaneous coronary intervention (PCI). Almost 900,000 patients were triaged through this STEMI network. The programme provided an umbrella of acute myocardial infarction protection to more than 100 million patients in Brazil, Colombia, Mexico, and Argentina. Mortality was reduced by 55% and the programme contributed to saving US$291 million. The results from LATIN (Latin America telemedicine network) trial surpass the total accumulated global experience with telemedicine.
Furthermore, the study investigators tested and proved four attributes of telemedicine: increased access; increased accuracy; cost-effectiveness; comprehensive, population-based care and delivery of guidelines-based acute myocardial infarction management
According to a press release, the programme was created as a hub and spoke model that was used to expand access. Patients presented at remote clinics and primary care centres and were guided through telemedicine to receive thrombolysis, pharmaco-invasive management, or primary PCI. The role of the telemedicine experts was two-fold: urgent and accurate STEMI diagnosis and tele consultation of the entire STEMI process. Time to telemedicine diagnosis (TTD) was 3.5 minutes and it was possible from tremendous investment in IT infrastructure, with use of cloud computing, business intelligence tools and with GPS navigation. LATIN established TTD as a novel metric of telemedicine efficiency.
Sameer Mehta, lead author of the study and chairman of the Lumen Foundation, said: “As Americans see the benefits of telemedicine in the COVID-19 era, the findings of the [LATIN investigation] should be more relevant and noteworthy. LATIN is the result of dedicated efforts of more than 2,000 healthcare professionals, including about 600 physicians that were involved in this decade old programme.”
He added: “LATIN has established the role of telemedicine in cost-effective and population-based management of acute myocardial infarction that reduces disparities of acute myocardial infarction care between developed and developing countries. It has provided a template that can be most beneficial for poorer regions on the world, including in sub-Saharan Africa, the Middle East and in southeast Asia. LATIN can also serve as a model of providing population-based coverage for other systems guided entities such as stroke.”
