Remote Acute Coronary Syndrome Chest Pain Triage by Electrocardiogram and Cardiac Biomarker Using Telemedicine.

BACKGROUND

Due to unawareness, many patients, particularly older ones, often misattribute cardiac pain to dyspepsia, leading to delayed acute coronary syndrome (ACS) diagnosis and failure to attain timely referral in resource-limited settings.

PROJECT RATIONALE: Differentiating ACS chest pain from noncardiac causes remains a challenge in remote settings where prompt triage by electrocardiogram and troponin can potentially save time and life.

PROJECT SUMMARY: We conducted baseline assessments on 43 patients over 2 months (group 1) at a remote health center. After setting up electrocardiogram and troponin testing, telemedicine service for test interpretation and referral guidance was provided. Concurrently, awareness initiatives were implemented. Data collected over next 4 months on 78 patients (group 2) showed significant awareness build-up, more ACS detection with loading antiplatelet treatment, and positive patient attitude (P < 0.05).

TAKE-HOME MESSAGE: It is possible to implement quality improvement initiatives in practice by utilizing existing resources properly and employing simple measures to improve patient outcomes.