Prehospital tele-electrocardiographic triage improves the management of acute coronary syndrome in rural populations: A systematic review and meta-analysis.
Gilbert LazarusH L KirchnerBambang B SiswantoPublished in: Journal of telemedicine and telecare (2020)
Twelve studies with a total of 3989 patients were included in this review. Prehospital telecardiology in the form of tele-electrocardiography (tele-ECG) enabled prompt diagnosis and triage, resulting in a decreased door-to-balloon (DTB) time (mean difference = -25.53 minutes, 95% confidence interval (CI) -36.08 to -14.97 minutes; I2 = 98%), as well as lower in-hospital mortality (odds ratio (OR) = 0.57, 95% CI 0.36-0.92) and long-term mortality (OR = 0.52, 95% CI 0.39-0.69) rates, both with negligible heterogeneity (I2 = 0%). GRADE assessment yielded very low to moderate certainty of evidence.Conclusion Prehospital tele-ECG appeared to be an effective and worthwhile approach in the management of rural ACS patients, as shown by moderate quality evidence on lower long-term mortality. Given the uncertainties of the evidence quality on DTB time and in-hospital mortality, future studies with a higher quality of evidence are required to confirm our findings.
Keyphrases
- acute coronary syndrome
- end stage renal disease
- cardiac arrest
- ejection fraction
- newly diagnosed
- emergency department
- chronic kidney disease
- south africa
- peritoneal dialysis
- prognostic factors
- cardiovascular events
- coronary artery disease
- heart failure
- risk factors
- type diabetes
- high intensity
- quality improvement
- patient reported outcomes
- antiplatelet therapy
- mitral valve
- emergency medical