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May 14, 2020

Telemedicine-Based Network Makes Remote PCI Guidance Available to 100 Million Patients

May 14, 2020— Findings from the LATIN study were presented as late-breaking science during the Society for Cardiovascular Angiography and Interventions (SCAI) 2020 Scientific Sessions Virtual Conference held May 14–16, 2020.

According to SCAI, the study examined the viability of telemedicine for remote guidance of a population-based ST-segment elevation myocardial infarction (STEMI) program reaching more than 100 million patients. The findings further prove that telemedicine transcends boundaries, enabling millions of patients to STEMI care access.

As summarized in the announcement, LATIN functioned between 2013 to the present in Brazil, Colombia, Mexico, and Argentina. Patients were triaged at spokes that included small clinics and primary health care centers in remote locations and transferred to hubs with percutaneous coronary intervention (PCI) capability.

Approximately 900,000 patients presenting at 351 remote locations were triaged through a STEMI network. The program provided an umbrella of acute myocardial infarction (AMI) protection to more than 100 million patients in Brazil, Colombia, Mexico, and Argentina. Mortality was reduced by 55% and the program contributed to saving $291 million. The results from the LATIN trial surpass the total accumulated global experience with telemedicine.

The study investigators tested and proved four attributes of telemedicine: increased access, increased accuracy, cost-effectiveness, and comprehensive population-based care and delivery of guidelines-based AMI management.

The program was created as a hub-and-spoke model that was used to expand access. Patients presented at remote clinics and primary care centers and were guided through telemedicine to receive thrombolysis, pharmaco-invasive management, or primary PCI. The role of the telemedicine experts was twofold: urgent and accurate STEMI diagnosis and teleconsultation of the entire STEMI process.

Time-to-telemedicine diagnosis (TTD) was 3.5 minutes, and it was made possible from tremendous investment in information technology infrastructure, with the use of cloud computing, business intelligence tools, and global positioning system navigation. LATIN established TTD as a novel metric of telemedicine efficiency.

“As Americans see the benefits of telemedicine in the COVID-19 era, the findings of the [LATIN investigation] should be more relevant and noteworthy,” commented the study’s lead author Sameer Mehta, MD, in the SCAI press release. “LATIN is the result of dedicated efforts of more than 2,000 health care professionals, including about 600 physicians [who] were involved in this decade-old program.”

Dr. Mehta continued, “LATIN has established the role of telemedicine in cost-effective and population-based management of AMI that reduces disparities of AMI care between developed and developing countries. It has provided a template that can be most beneficial for poorer regions [of] the world, including in sub-Saharan Africa, the Middle East, and in southeast Asia. LATIN can also serve as a model of providing population-based coverage for other systems-guided entities such as stroke."

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