AHA: Pre-hospital ECGs are cost effective for STEMI patients
Integrating pre-hospital intervention, including ECG transmissions, and having a cardiologist on site during presentation at the hospital is a cost-effective model for STEMI patients in communities with adequate patient volume, according to a poster presented at this year’s annual American Heart Association (AHA) Scientific Sessions in Chicago.

To evaluate the costs of pre-hospital diagnostics and in-hospital care for STEMI patients, Daniel M. Frendl, of the University of Massachusetts Medical School in Worcester, Mass., and colleagues compared pre-intervention cost of care and time to treatment for STEMI patients who arrived for a catheterization via self-transport, paramedics or paramedics who transmit prehospital ECGs to interventionalists in-hospital to bypass the emergency department.

During the study, Frendl and colleagues evaluated a population of 256,500 in Durham County, N.C., which included two hospitals and 10 ambulances that transported an estimated 43 STEMI patients per year.

Frednl et al found that pre-hospital ECG transmission was a dominant treatment strategy that cost less and had a decreased onset-to-treatment time when compared to standard paramedic transport at volumes of over 31 patients per year.

In addition, the researchers found that the costs to integrate wireless prehospital ECG transmissions were less than $10 per minute of pre-intervention time compared to self-transport.

When comparing patient transport with transport where ECG’s were transmitted via paramedic, the researchers found that mean door-to-balloon (D2B) times were lower in the patients whose information was transmitted directly to the hospital, 102 minutes versus 49 minutes, respectively.

In addition, the mean pre-PCI costs for self-transport, paramedic transport and paramedic transport via ECG transmission were $819, $1,371 and $1,179, respectively.

The mean pre-PCI times for the aforementioned transport methods were 122 minutes, 144 minutes and 86 minutes, respectively.

In order to perform a sensitivity analysis, the researchers reduced the number of interventionalists who were available to treat patients from 80 percent to 50 percent, and upon this reduction, “pre-hospital ECG transmission remained economically attractive.”

The authors concluded: “In communities with adequate patient volume, cardiologist on-site availability and paramedic coverage, pre-hospital ECG transmission is cost effective for patients with STEMI.”