WhatsApp Speeds Up Heart Attack Treatment Time

Diagnostic electrocardiograms (ECGs) sent directly to hospital catheterization labs via WhatsApp enable triaged patients to bypass the emergency department (ED), according to a new study.

Researchers at Insituto Cardiovascular de Buenos Aires (ICBA; Argentina) and Sanatorio Anchorena (Buenos Aires, Argentina) conducted a study that prospectively enrolled 896 patients who underwent ST-segment elevation myocardial infarction (STEMI) between 2012 and 2016. Hospital admission occurred by three routes - patients arrived at the emergency department by their own means; ambulance delivered patients to the ED; and ambulance delivered patients to the catheterization (cath) lab, with the ED bypassed.

In the third group, an ambulance doctor conducted an ECG on arrival at the patient's home or public place. If STEMI was the diagnosis, the ECG was transmitted via WhatsApp a cardiologist at the hospital to confirm diagnosis and prepare the cath lab. On arrival, patients were taken directly to the cath lab and did not stop in the ED. The researchers then compared treatment times and outcomes between all patient groups to determine if direct transfer to the cath lab led to quicker treatment, and to evaluate the impact of direct transfer on left ventricular ejection fraction (LVEF), length of hospital stay, and mortality.

The results showed that the time between symptom onset and treatment was significantly lower in the Whatsapp group (150 minutes) than the other two groups (200 minutes). The overall mortality rate of all STEMI patients in the study was 2.23%, but mortality was significantly lower in the Whatsapp group (0.83%) than the other groups (3.17%). Patients in the Whatsapp group also had a shorter hospital stay (4.88 days versus 5.58 days), and better LVEF at discharge (51% versus 48%). The study was presented at the Argentine Congress of Cardiology (SAC), held during October 2017 in Buenos Aires (Argentina).

“Patients have the best chance of survival when they receive primary angioplasty to restore blood flow to blocked arteries within 90 minutes of contacting the health service. Advanced notification enables hospital staff to prepare the cath lab, and the doctor is ready to start primary angioplasty when the patient arrives,” said lead author cardiologist Nicolás Lalor, MD, of ICBA and Sanatorio Anchorena. “Using WhatsApp on a smartphone is a cheap and easy way for ambulance and hospital doctors to communicate, and we will be rolling this procedure out to other hospitals in Argentina.”

“This is a very easy way to improve the treatment of acute myocardial infarction in our country,” commented Alberto Fernández, MD, scientific program coordinator of SAC 2017. “Given the very long distances between centers that have percutaneous transluminal coronary angioplasty facilities, particularly in cities in the interior of the country, the opportunity to call the interventional cardiologist and prepare the cath lab could improve the prognosis of patients.”

Alteplase is a recombinant tissue plasminogen activator (tPA) made by Genentech, which is found in the human body as a serine protease on endothelial cells that line the blood vessels. As an enzyme, it catalyzes the conversion of plasminogen to plasmin, the major enzyme responsible for clot breakdown. Use of tPA is contraindicated in hemorrhagic stroke and head trauma.

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