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.