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Nakashima T, Hashiba K, Kikuchi M, Yamaguchi J, Kojima S, Hanada H, Mano T, Yamamoto T, Tanaka A, Matsuo K, Nakayama N, Nomura O, Matoba T, Tahara Y, Nonogi H. Impact of Prehospital 12-Lead Electrocardiography and Destination Hospital Notification on Mortality in Patients With Chest Pain ― A Systematic Review ―. Circ Rep 2022; 4:187-193. [PMID: 35600724 PMCID: PMC9072100 DOI: 10.1253/circrep.cr-22-0003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/16/2022] [Accepted: 03/13/2022] [Indexed: 12/31/2022] Open
Affiliation(s)
- Takahiro Nakashima
- Department of Emergency Medicine and Michigan Center for Integrative Research in Critical Care, University of Michigan
| | | | - Migaku Kikuchi
- Department of Cardiovascular Medicine, Emergency and Critical Care Center, Dokkyo Medical University
| | | | - Sunao Kojima
- Department of Internal Medicine, Sakurajyuji Yatsushiro Rehabilitation Hospital
| | - Hiroyuki Hanada
- Department of Emergency and Disaster Medicine, Hirosaki University
| | | | - Takeshi Yamamoto
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital
| | - Akihito Tanaka
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Kunihiro Matsuo
- Department of Acute Care Medicine, Fukuoka University Chikushi Hospital
| | - Naoki Nakayama
- Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center
| | - Osamu Nomura
- Department of Emergency and Disaster Medicine, Hirosaki University
| | - Tetsuya Matoba
- Department of Cardiovascular Medicine, Kyushu University Faculty of Medical Sciences
| | - Yoshio Tahara
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
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Szabó GT, Ágoston A, Csató G, Rácz I, Bárány T, Uzonyi G, Szokol M, Sármán B, Jebelovszki É, Édes IF, Czuriga D, Kolozsvári R, Csanádi Z, Édes I, Kőszegi Z. Predictors of Hospital Mortality in Patients with Acute Coronary Syndrome Complicated by Cardiogenic Shock. SENSORS (BASEL, SWITZERLAND) 2021; 21:969. [PMID: 33535491 PMCID: PMC7867036 DOI: 10.3390/s21030969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/21/2021] [Accepted: 01/26/2021] [Indexed: 11/17/2022]
Abstract
As demonstrated by earlier studies, pre-hospital triage with trans-telephonic electrocardiogram (TTECG) and direct referral for catheter therapy shows great value in the management of out-of-hospital chest pain emergencies. It does not only improve in-hospital mortality in ST-segment elevation myocardial infarction, but it has also been identified as an independent predictor of higher in-hospital survival rate. Since TTECG-facilitated triage shortens both transport time and percutaneous coronary intervention (PCI)-related procedural time intervals, it was hypothesized that even high-risk patients with acute coronary syndrome (ACS) and cardiogenic shock (CS) might also benefit from TTECG-based triage. Here, we decided to examine our database for new triage- and left ventricular (LV) function-related parameters that can influence in-hospital mortality in ACS complicated by CS. ACS patients were divided into two groups, namely, (1) hospital death patients (n = 77), and (2) hospital survivors (control, n = 210). Interestingly, TTECG-based consultation and triage of CS and ACS patients were confirmed as significant independent predictors of lower hospital mortality risk (odds ratio (OR) 0.40, confidence interval (CI) 0.21-0.76, p = 0.0049). Regarding LV function and blood chemistry, a good myocardial reperfusion after PCI (high area at risk (AAR) blush score/AAR LV segment number; OR 0.85, CI 0.78-0.98, p = 0.0178) and high glomerular filtration rate (GFR) value at the time of hospital admission (OR 0.97, CI 0.96-0.99, p = 0.0042) were the most crucial independent predictors of a decreased risk of in-hospital mortality in this model. At the same time, a prolonged time interval between symptom onset and hospital admission, successful resuscitation, and higher peak creatine kinase activity were the most important independent predictors for an increased risk of in-hospital mortality. In ACS patients with CS, (1) an early TTECG-based teleconsultation and triage, as well as (2) good myocardial perfusion after PCI and a high GFR value at the time of hospital admission, appear as major independent predictors of a lower in-hospital mortality rate.
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Affiliation(s)
- Gábor Tamás Szabó
- Department of Cardiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (I.R.); (T.B.); (M.S.); (D.C.); (R.K.); (Z.C.); (I.É.); (Z.K.)
| | - András Ágoston
- The III: Department of Internal Medicine, Szabolcs–Szatmár–Bereg County Hospitals and University Teaching Hospital, 4400 Nyíregyháza, Hungary;
| | - Gábor Csató
- Hungarian National Ambulance Service, 1024 Budapest, Hungary;
| | - Ildikó Rácz
- Department of Cardiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (I.R.); (T.B.); (M.S.); (D.C.); (R.K.); (Z.C.); (I.É.); (Z.K.)
| | - Tamás Bárány
- Department of Cardiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (I.R.); (T.B.); (M.S.); (D.C.); (R.K.); (Z.C.); (I.É.); (Z.K.)
| | - Gábor Uzonyi
- Department of Cardiology, Uzsoki Hospital, 1145 Budapest, Hungary; (G.U.); (B.S.)
| | - Miklós Szokol
- Department of Cardiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (I.R.); (T.B.); (M.S.); (D.C.); (R.K.); (Z.C.); (I.É.); (Z.K.)
| | - Balázs Sármán
- Department of Cardiology, Uzsoki Hospital, 1145 Budapest, Hungary; (G.U.); (B.S.)
| | - Éva Jebelovszki
- Department of Cardiology, Faculty of Medicine, University of Szeged, 6725 Szeged, Hungary;
| | - István Ferenc Édes
- Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary;
| | - Dániel Czuriga
- Department of Cardiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (I.R.); (T.B.); (M.S.); (D.C.); (R.K.); (Z.C.); (I.É.); (Z.K.)
| | - Rudolf Kolozsvári
- Department of Cardiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (I.R.); (T.B.); (M.S.); (D.C.); (R.K.); (Z.C.); (I.É.); (Z.K.)
| | - Zoltán Csanádi
- Department of Cardiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (I.R.); (T.B.); (M.S.); (D.C.); (R.K.); (Z.C.); (I.É.); (Z.K.)
| | - István Édes
- Department of Cardiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (I.R.); (T.B.); (M.S.); (D.C.); (R.K.); (Z.C.); (I.É.); (Z.K.)
| | - Zsolt Kőszegi
- Department of Cardiology, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary; (I.R.); (T.B.); (M.S.); (D.C.); (R.K.); (Z.C.); (I.É.); (Z.K.)
- The III: Department of Internal Medicine, Szabolcs–Szatmár–Bereg County Hospitals and University Teaching Hospital, 4400 Nyíregyháza, Hungary;
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Papai G, Csato G, Racz I, Szabo G, Barany T, Racz A, Szokol M, Sarman B, Edes IF, Czuriga D, Kolozsvari R, Edes I. The transtelephonic electrocardiogram-based triage is an independent predictor of decreased hospital mortality in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention. J Telemed Telecare 2018; 26:216-222. [PMID: 30526257 PMCID: PMC7222284 DOI: 10.1177/1357633x18814335] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The transtelephonic electrocardiogram has been shown to have a great value in the management of out-of-hospital chest pain emergencies. In our previous study it not only improved the pre-hospital medical therapy and time to intervention, but also the in-hospital mortality in ST-segment elevation myocardial infarction. It was hypothesised that the higher in-hospital survival rate could be due to improved transtelephonic electrocardiogram-based pre-hospital management (electrocardiogram interpretation and teleconsultation) and consequently, better coronary perfusion of patients at the time of hospital admission. To test this hypothesis, our database of ST-segment elevation myocardial infarction patients was evaluated retrospectively for predictors (including transtelephonic electrocardiogram) that may influence in-hospital survival. METHODS AND RESULTS The ST-segment elevation myocardial infarction patients were divided into two groups, namely (a) hospital death patients (n = 49) and (b) hospital survivors (control, n = 726). Regarding pre-hospital medical management, the transtelephonic electrocardiogram-based triage (odds ratio 0.48, confidence interval 0.25-0.92, p = 0.0261) and the administration of optimal pre-hospital medical therapy (acetylsalicylic acid and/or clopidogrel and glycoprotein IIb/IIIa inhibitor) were the most important independent predictors for a decreased risk in our model. At the same time, age, acute heart failure (Killip class >2), successful pre-hospital resuscitation and total occlusion of the infarct-related coronary artery before percutaneous coronary intervention were the most important independent predictors for an increased risk of in-hospital mortality. DISCUSSION In ST-segment elevation myocardial infarction patients, (a) an early transtelephonic electrocardiogram-based teleconsultation and triage, (b) optimal pre-hospital antithrombotic medical therapy and (c) the patency and better perfusion of the infarct-related coronary artery on hospital admission are important predictors of a lower in-hospital mortality rate.
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Affiliation(s)
| | - Gabor Csato
- Hungarian National Ambulance Service, Hungary
| | - Ildiko Racz
- Division of Cardiology, University of Debrecen, Hungary
| | - Gabor Szabo
- Division of Cardiology, University of Debrecen, Hungary
| | - Tamas Barany
- Division of Cardiology, University of Debrecen, Hungary
| | - Agnes Racz
- Division of Cardiology, University of Debrecen, Hungary
| | - Miklos Szokol
- Division of Cardiology, University of Debrecen, Hungary
| | | | - Istvan F Edes
- Heart and Vascular Center, Semmelweis University, Hungary
| | | | | | - Istvan Edes
- Division of Cardiology, University of Debrecen, Hungary
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Winburn AS, Brixey JJ, Langabeer J, Champagne-Langabeer T. A systematic review of prehospital telehealth utilization. J Telemed Telecare 2017; 24:473-481. [PMID: 29278996 DOI: 10.1177/1357633x17713140] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective There has been moderate evidence of telehealth utilization in the field of emergency medicine, but less is known about telehealth in prehospital emergency medical services (EMS). The objective of this study is to explore the extent, focus, and utilization of telehealth for prehospital emergency care through the analysis of published research. Methods The authors conducted a systematic literature review by extracting data from multiple research databases (including MEDLINE/PubMed, CINAHL Complete, and Google Scholar) published since 2000. We used consistent key search terms to identify clinical interventions and feasibility studies involving telehealth and EMS, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results We identified 68 articles focused specifically on telehealth interventions in prehospital care. The majority (54%) of the studies involved stroke and acute cardiovascular care, while only 7% of these (4) focused on telehealth for primary care. The two most common delivery methods were real-time video-conferencing capabilities (38%) and store and forward (25%); and this variation was based upon the clinical focus. There has been a significant and positive trend towards greater telehealth utilization. European telehealth programs were most common (51% of the studies), while 38% were from the United States. Discussion and Conclusions Despite positive trends, telehealth utilization in prehospital emergency care is fairly limited given the sheer number of EMS agencies worldwide. The results of this study suggest there are significant opportunities for wider diffusion in prehospital care. Future work should examine barriers and incentives for telehealth adoption in EMS.
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Rogers H, Madathil KC, Agnisarman S, Narasimha S, Ashok A, Nair A, Welch BM, McElligott JT. A Systematic Review of the Implementation Challenges of Telemedicine Systems in Ambulances. Telemed J E Health 2017; 23:707-717. [PMID: 28294704 DOI: 10.1089/tmj.2016.0248] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Telemedicine systems are gaining attention nationwide as a means for providing care in remote areas and allowing a small number of providers to impact a large geographic region. We systematically reviewed the literature to identify the efficacy and implementation challenges of telemedicine systems in ambulances. METHODS A search for published studies on Web of Science and PubMed was completed. Studies were selected if they included at least a pilot study and they focused on feasibility or implementation of telemedicine systems in ambulances. RESULTS A total of 864 articles were used for title and abstract screening. Full text screening was completed for 102 articles, with 23 being selected for final review. Sixty-one percent of the studies included in the review focused on general emergency care, while 26% focused on stroke care and 13% focused on myocardial infarction care. The reviewed studies found that telemedicine is feasible and effective in decreasing treatment times, report a high diagnosis accuracy rate, show higher rates of positive task completion than in regular ambulances, and demonstrate that stroke evaluation is completed with comparable accuracy to the standard way of delivering care. CONCLUSIONS Although this review identified life-saving benefits of telemedicine, it also showed the paucity of the scientifically sound research in its implementation, prompting further studies. Further research is needed to analyze the capabilities and challenges involved in implementing telemedicine in ambulances, especially studies focusing on human-system integration and human factors' considerations in the implementation of telemedicine systems in ambulances, the development of advanced Internet connectivity paradigms, additional applications for triaging, and the implications of ambulance location.
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Affiliation(s)
- Hunter Rogers
- 1 Department of Industrial Engineering, Clemson University , Clemson, South Carolina
| | - Kapil Chalil Madathil
- 1 Department of Industrial Engineering, Clemson University , Clemson, South Carolina.,2 Department of Civil Engineering, Clemson University , Clemson, South Carolina.,3 Department of Public Health Sciences, Medical University of South Carolina , Charleston, South Carolina
| | - Sruthy Agnisarman
- 2 Department of Civil Engineering, Clemson University , Clemson, South Carolina
| | - Shraddhaa Narasimha
- 1 Department of Industrial Engineering, Clemson University , Clemson, South Carolina
| | - Aparna Ashok
- 4 School of Dental Medicine, Southern Illinois University at Edwardsville , Alton, Illinois
| | - Aswathi Nair
- 2 Department of Civil Engineering, Clemson University , Clemson, South Carolina
| | - Brandon M Welch
- 3 Department of Public Health Sciences, Medical University of South Carolina , Charleston, South Carolina
| | - James T McElligott
- 5 South Carolina Telehealth Alliance, Medical University of South Carolina , Charleston, South Carolina
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Lamas E, Miguel S, Muehlan H, Schmidt S, Salinas RA. Assessing ethical and social issues of transtelephonic electrocardiography (TTEGG) in Chile. CAD SAUDE PUBLICA 2016; 30:2571-7. [PMID: 26247986 DOI: 10.1590/0102-311x00012114] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 07/10/2014] [Indexed: 11/21/2022] Open
Abstract
The aim of this study was to focus on the ethical and social issues derived from the implementation of transtelephonic electrocardiography (TTECG) in the public healthcare sector in Chile, studying patients and healthcare providers' acceptance and expectations concerning: (a) TTECG effectiveness and safety; and (b) data protection issues, such as confidentiality, privacy and security. For this purpose, we developed two psychosocial surveys; the first was addressed to patients receiving transtelephonic electrocardiogram (either in the emergency services of hospitals or in distant primary care services) and the second one aimed at healthcare providers involved in either administering and/or interpreting it. Results included: (a) major acceptability of TTECG in terms of safety and security; (b) privacy and confidentiality of the patients were considered to be well protected; and (c) the patient-doctor relationship was not affected by this device.
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Affiliation(s)
- Eugenia Lamas
- Institut National de la Santé et de la Recherche Médicale, Paris, France
| | - Silvia Miguel
- Institut National de la Santé et de la Recherche Médicale, Paris, France
| | - Holger Muehlan
- Institute of Psychology, Ernst-Moritz-Arndt-University, Greifswald, Germany
| | - Silke Schmidt
- Institute of Psychology, Ernst-Moritz-Arndt-University, Greifswald, Germany
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Cheng TO. In China women uphold half of the sky, but only a quarter of them received reperfusion therapy for acute coronary syndrome. Int J Cardiol 2014; 177:317-9. [DOI: 10.1016/j.ijcard.2014.06.064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Accepted: 06/29/2014] [Indexed: 12/26/2022]
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