Smartphone communication streamlines hospital transfers for heart attack patients

The study tracked the length of time patients with ST-elevated myocardial infarction, or STEMI, the most severe type of heart attack, suffered a reduction in blood supply, known as ischemia, while waiting to undergo a procedure to open their blocked arteries. The researchers found patients needing a hospital transfer received this procedure on average 27 minutes faster when their medical teams used a smartphone app-based social network system (SNS) to coordinate the hospital transfer compared to teams communicating with a non-smartphone based STEMI hotline. The benefit was especially pronounced during nights and weekends, when on-call medical teams may be off site and have to travel to the hospital to perform the procedure.

"SNS activation is a simple and cost-effective method suitable for broad utilization and implementation among health care providers to reduce the total ischemic time for transferred STEMI patients," said Jin Joo Park, M.D., assistant professor of internal medicine at Seoul National University Bundang Hospital, South Korea, and one of the study's senior researchers. "In my opinion, SNS activation can potentially save lives without using new resources in the health care system."

Percutaneous coronary intervention (PCI), also known as angioplasty, is the preferred and most common treatment for opening blocked arteries and restoring blood flow, known as reperfusion, in STEMI patients. However, not all hospitals are equipped to perform this procedure and some can only perform it during weekdays. Previous research has shown that patients requiring a hospital transfer before receiving PCI have a longer total ischemic time and worse outcomes.

Seeking to reduce the time patients must wait to receive this lifesaving treatment, researchers connected health care providers at five non-PCI equipped hospitals with providers at Seoul National University Bundang Hospital, which has around-the-clock PCI capabilities, via a smartphone application known as BAND. BAND is a popular social networking app in South Korea that facilitates communication among groups.

When transferring a STEMI patient to the hospital, physicians used the app to send the interventional cardiologist basic patient information along with a picture of the patient's electrocardiogram taken with a smartphone camera. The interventional cardiologist used this information to rapidly gather a team to perform PCI, paging on-call personnel when needed, so that in most cases the responding team assembled at the hospital before the transfer patient entered the Seoul National University Bundang Hospital Emergency Department.

The study enrolled 114 STEMI patients transferred to Seoul National University Bundang Hospital during an 18-month period. Fifty of the patients were transferred using the SNS app and the rest were transferred using a non-smartphone based STEMI hotline. SNS was associated with a 27-minute reduction, on average, in the length of time from first medical contact to receiving PCI. One key factor that likely contributed to this reduction was the time spent waiting to undergo PCI after arriving at the second hospital, which was more than 15 minutes shorter when SNS was used to facilitate a transfer for patients presenting during off-hours. The use of SNS in these cases reduced the wait time at the second hospital to that experienced by patients arriving during weekdays.

"Transferred STEMI patients rarely achieve timely reperfusion due to delays in the transfer process, especially when transferred during off-hours," Park said, noting that there is strong evidence that STEMI patients arriving to a hospital off-hours face a higher risk of death, a trend observed worldwide. "The use of a smartphone SNS can help to achieve timely reperfusion for transferred STEMI patients with rapid, seamless communication among health care providers."

The time spent in transit between the two hospitals was similar in both groups. The time spent at the first hospital before being transferred was numerically shorter in the SNS-activated group, but this difference was not statistically significant.

Ischemia deprives tissues of oxygen, causing damage to the heart. If blood flow is not restored quickly enough, STEMI can lead to death or the permanent loss of heart tissue, resulting in long-term health effects and increasing the risk of another heart attack.

The study is limited in that it is not a randomized controlled trial and does not assess whether the use of SNS to streamline the transfer process actually saves patients' lives or improves their quality of life. Park and his team are currently planning a randomized clinical trial to provide a more rigorous evaluation of the potential impact of SNS use on these outcomes.