P209 - EFFECT OF A CLOUD-BASED CARE COORDINATION PLATFORM ON TREATMENT DELAYS IN STEMI PATIENTS IDENTIFIED IN A SPOKE EMERGENCY ROOM OF A HUB-AND-SPOKE SYSTEM

Background: In ST-elevation myocardial infarction (STEMI), rapid diagnosis and cardiac catheterization lab activation are critical to achieve prompt coronary reperfusion. The Stenoa app allows communication between emergency medical services (EMS), emergency room (ER) physicians, and interventional cardiologists, to enable direct coordination of STEMI patient care. This study assessed Stenoa’s impact on treatment delays for STEMI patients transferred from the Suroît region within a hub-and-spoke system.

METHODS AND RESULTS: A retrospective cohort study compared STEMI treatment delays before (March 2020–September 2021) and after (September 2021–May 2024) Stenoa implementation at the McGill University Health Centre (MUHC) for patient from the Suroît region. Results were evaluated across three groups: Group 1 (EMS transfer to MUHC cath lab from Suroît region), Group 2 (Suroît ER transfer to MUHC cath lab), and Group 3 (EMS transfer to Suroît ER, then transfer to MUHC cath lab). This sub-analysis considers Groups 2 and 3. The primary outcome was first medical contact (FMC) to reperfusion time. Intermediary delays for STEMI activation were also assessed.

A total of 222 STEMI patients were identified, with a mean age of 64±13 years, and 75% were male. Groups 1, 2 and 3 consisted of 127, 61, and 34 patients, respectively. Median FMC-to-reperfusion delays were significantly longer in Groups 2 and 3 (92 vs 118 vs 137 min, respectively; p< 0.001). No significant reductions were observed in Groups 2 and 3 before vs. after Stenoa implementation (Group 2: from 122 to 119 min; p=0.39; Group 3: from 137 to 142 min; p=0.51). In Group 2, Stenoa was associated to a numerical decrease in FMC-to-activation (from 33.5 to 25 minutes; p = 0.43) offset by a numerical increase in activation-to-door-out (from 21.9 to 26 minutes, p=0.47).

Conclusion: Stenoa implementation did not significantly reduce treatment delays for STEMI patients identified in a spoke emergency room. Larger studies are needed to determine if the benefits of care coordination platforms are outweighed by ambulance delays in transferring patients from spokes to hubs. As digital solutions become more integral to healthcare, addressing logistical challenges is essential to realizing their full potential in improving patient outcomes.