Managing STEMI & other time sensitive cardiac emergencies by using smart phones-a study utilizing social media as tool to integrate local health network in remote areas of India-save Heart initiative
Authors: Bhat I , Hafeez I , Zargar M , Shamas N , Jalali A 
Published: November 2020

Abstract

Introduction
Kashmir is a resource limited, region of India having its own distinctive regional challenges, operational limitations and poor accessibility of remote areas to health care. Utilizing smart phones as a medium for providing access to the optimum cardiac care in the remotest of the areas of our region served as a platform for SAVE HEART INITIATIVE (SHI) launched in the form of Social Media Whatsapp Group connecting peripheral hospitals (spokes) in the Kashmir region to experts (Hub).

Material and methods
SHI, a novel initiative was started voluntarily by a team of cardiologists and physicians. All the government hospitals along with their Emergency (ER) teams were roped in, integrated with expert physicians and cardiologists via whats app based technology creating a virtual cardiac ER facility and a CYBER HUB where teams of experts lended optimum support to all the peripheral hospitals of the region which acted as CYBER SPOKES of the initiative. Simultaneously all the peripheral hospitals upgraded to a functional Emergency room with all the emergency drugs available including the clot busters as streptokinase and vital anti arrhythmic drugs free of cost. Emergency room proformas, algorithms, protocols were created and standardized to aid in management. CME's regarding cardiac emergencies and response workshops were organized at regional institutes regularly for capacity building locally. The decision to use whatsapp as technology in medical care was taken due to its unique features of being readily available, handy technology, and as it could transfer all data in form of text, images, audios, visuals to and from the cyber spokes and cyber hubs respectively.

Results
Within 500 days of the initiative about 130 hospitals and 1200 doctors were taken on board. A total of 38000 ECGs were analyzed till date wherein the average response time in this social media group to any case was 1–2 minutes mostly and the diagnostic delays decreased to minimum. This initiative managed 950 STEMI's with thrombolysis, 2723 NSTEMI, 5320 arrhythmias, 345 heart blocks, 16 pulmonary thrombo-embolisms, 53 PCI decisions.

Conclusion
Our experiment demonstrated the feasibility of the approach adopted for better cardiac care that reached the poorest living in far flung area without any extra burden to the state exchequer. SHI reduced morbidity, mortality; CCU occupancy rate in tertiary care brought down undue referrals and established a vibrant patient tracking system in the region depicting its success. Using Smartphone based technology in time sensitive cardiac events seems to be the most vibrant, novel and viable option being available, portable, efficient, and cost-effective, with least technical glitches. It seems to be the way forward in providing optimum and timely treatment in all acute cardiac emergencies in resource deficient regions as Kashmir.

Funding Acknowledgement
Type of funding source: None