Canadian Journal of Cardiology



      ST-segment Elevation Myocardial Infarction (STEMI) requires efficient communication and collaboration to ensure timely care. The current model for STEMI activation often relies on telephone and fax. While secure, fax is often slow, inefficient, and inaccessible. To speed up the process, clinicians often use text messaging, which is not secure, or activation without ECG review, which increases the risk of false activation. This study describes the feasibility of using a secure smartphone application for STEMI activation that uses a novel and secured mobile phone application.


      A 6-month pilot study was performed using a smartphone application to facilitate communication between emergency medicine physicians in three community hospitals with interventional cardiologists at a tertiary care cardiac centre. A voluntary, anonymous post-intervention survey was conducted upon completion of the study. Analytics on use of the application were collected in an anonymous, de-identified manner using Google Analytics for Firebase. Internal and external privacy testing confirmed that the application was privacy compliant. Research Ethics Board approval was obtained. A total of 52 emergency medicine physicians, including all full-time physicians, and 10 interventional cardiologists participated in this 6-month pilot study between May 1, 2020 and October 31, 2020. Physicians were onboarded between April 24, 2020 and May 1, 2020. Data from a total of 130 patients were reviewed via the smartphone application and 69 of these resulted in STEMI activation. There were no application failures; the application had a 100% success rate in transmitting 244 ECGs during this study. During the pilot study, 68% of all STEMIs were activated via the smartphone application. The proportion of cases activated via the application over the course of the study increased from 69% to 77%. At the end of the 6-month pilot study, 17 emergency medicine physicians completed the post-intervention survey. There was high physician satisfaction in the application: 88% liked the application (0% disliked) and 82% would recommend the application to a colleague (0% would not recommend).


      This study demonstrates real-world feasibility and usability of a novel, fast, secure, easy-to-use, point-of-care smartphone application for STEMI activation. The application did not have any technical failures, had sustained use and growth with a high degree of physician satisfaction. A larger study is underway to assess the impact of this intervention on patient outcomes, including timing of care and false activation rates.
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