JMIR Publications

ABSTRACT

Background:

Timely diagnosis and access to treatment for ST Elevation Myocardial Infarction (STEMI) requires a coordinated response from multiple providers. Rapid intervention is key to reduce mortality and morbidity. Activation of the cardiac catheterization laboratory may occur via verbal communication and may also involve the secure sharing of electrocardiogram (ECG) images between front-line healthcare providers and interventional cardiologists (ICs). To improve this coordinated response through a stream-lined communication pathway, we developed a quick, easy-to-use, privacy-compliant smartphone application (SMART AMI-ACS) for real-time verbal communication and ECG sharing between healthcare providers in Ontario, Canada. The App further provides information about diagnosis, management and risk calculators for patients presenting with an acute coronary syndrome.

Objective:

Integrating the App into workflow processes aims to improve communication for STEMI activation, resulting in decreased treatment times, improved patient outcomes, and reducing unnecessary catheterization laboratory activation and/or transfer.

Methods:

Implementation of the App will be guided by the RE-AIM framework to measure impact. The study will use quantitative registry data already being collected via the ongoing SMART-AMI project (STEMI registry), utilization of data collected from the SMART AMI App, and quantitative and qualitative survey data from participating physicians. Survey questions will be generated based on selected components of the Consolidated Framework for Implementation Research. Descriptive quantitative analysis and thematic qualitative analysis of survey results will be conducted. Continuous variables will be described using either mean and standard deviation or median and interquartile range (25th and 75th percentiles) at pre- and post-intervention periods by the study sites. Categorical variables, such as false activation, will be described as frequencies (percentages). For each outcome, an interrupted time series regression model will be fitted to evaluate the impact of the App besides any underlying trend after adjusting for potential confounders, patient’s demographic, and clinical characteristics; days of week; times of day; and seasons.

Results:

The primary outcomes of this study include usability, acceptability and functionality of the App for emergency medicine (EM) physicians. This will be measured using electronic surveys to identify barriers and facilitators to App use. Other key outcomes will measure implementation of the App through reviewing timing of care intervals, false “avoidable” catheterization laboratory activation rates, and uptake and use of the App by participating physicians. Prospective evaluation will be conducted between April 1, 2022 to March 31, 2023. However, for the timing and accuracy of care outcomes, registry data will be compared from January 1, 2019 to March 31, 2023

Conclusions:

Smartphone technology is well integrated into clinical practice and widely accessible. The proposed solution being tested is secure and leverages the accessibility of smartphones. EM physicians can use this App to quickly, securely, and accurately transmit information ensuring faster and appropriate decision making for STEMI activation. Clinical Trial: https://clinicaltrials.gov/study/NCT05290389