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This trial will prospectively evaluate the impact of integrating AI-ECG within the pay-for-performance program on improving the diagnosis, treatment, and clinical outcomes of occlusion myocardial infarction patients by promoting accurate and timely diagnoses through financial incentives.
The investigators have developed an AI-ECG system that provides real-time notifications for patients with potential occlusion myocardial infarction. This AI algorithm is seamlessly integrated into the Hospital Information System, allowing for the automatic generation of reports whenever an ECG is performed. The purpose of this study is to evaluate the impact of AI-ECG on the timely diagnosis of STEMI, including patients' outcomes and healthcare costs.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| AI-ECG P4P program | Experimental | AI-ECG-assisted detection of OMI within the P4P program. The AI-ECG system will conduct a real-time analysis of the ECG. When the system identifies potential OMI cases, it will immediately send short message service notifications to the on-duty cardiologists. This will enable the cardiologists to promptly review and confirm the diagnosis. |
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| Standard of care | No Intervention | Potential OMI patients will be initially assessed by frontline physicians. If OMI is suspected, the frontline physicians will promptly notify the on-duty cardiologists, who will then review the case for confirmation. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| AI-ECG P4P program | Other | The AI-ECG system will conduct a real-time analysis of the ECG. When the system identifies potential OMI cases, it will immediately send short message service notifications to the on-duty cardiologists. This will enable the cardiologists to promptly review and confirm the diagnosis. |
| Measure | Description | Time Frame |
|---|---|---|
| D-to-W time (Door to Wire Time) | Door-to-wire time refers to the duration from a patient's arrival at the emergency department (ED) to the successful placement of a wire into the coronary artery during a primary percutaneous coronary intervention (PPCI) procedure. | From the start of the emergency visit to the following 48 hours. |
| Cost Outcome Measure | Total expenditures, from the start of the emergency visit to 90 days post-discharge (in USD), for comparison between the intervention and control groups, based on records from NHI (National Health Insurance) claims data. | From the start of the emergency visit to 90 days post-discharge. |
| Measure | Description | Time Frame |
|---|---|---|
| Door-to-Wire time less than 90 minutes | The proportion of patients achieving a Door-to-Wire time of less than 90 minutes in the intervention group compared to the control group. The intervention and control groups' door-to-wire time will be compared. Door-to-wire time is defined as the duration from the first ECG to the successful placement of the wire during PPCI for OMI patients in the emergent department. |
| Measure | Description | Time Frame |
|---|---|---|
| Emergent CAG without PCI | The number of patients who received emergent coronary angiograms without lesions need intervention. | From the start of the emergency visit to the following 48 hours. |
| Procedure related vascular complications |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Chin Lin, PhD | Contact | +886-2-8792-3100 | 18574 | xup6fup@mail.ndmctsgh.edu.tw |
| Name | Affiliation | Role |
|---|---|---|
| Chin Lin, PhD | National Defense Medical Center | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Kaohsiung Armed Forces General Hospital | Recruiting | Kaohsiung City | Taiwan | 807 | Taiwan |
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| 48 hours |
| In-hospital all-cause Mortality Rate | The proportion of patients who die from any cause, regardless of the underlying condition, during hospitalization. | 90-day follow |
| In-hospital cardiac death | The proportion of patients who die from cardiovascular-related causes during hospitalization. | 90-day follow |
| Length of ICU | Comparison of length of ICU between the intervention and control groups. | 90-day follow |
| Length of hospitalization | Comparison of length of hospitalization between the intervention and control groups. | 90-day follow |
| Cardiovascular events | Composite cardiovascular events (Non-fatal MI + Non-fatal stroke + CV Death) The rate of composite cardiovascular events within 90 days. | 90-day follow |
| Non-fatal MI | The rate of non-fatal MI within 90-days. | 90-day follow |
| Non-fatal stroke (Ischemic stroke + Hemorrhagic stroke) | The rate of non-fatal strokes (both ischemic and hemorrhagic) within 90-days. | 90-day follow |
| Cardiac Death | The proportion of patients who die from cardiovascular-related causes within 90-days. | 90-day follow |
| Ischemic stroke | The incidence of ischemic stroke. | 90-day follow |
| Hemorrhagic stroke | The incidence of hemorrhagic stroke. | 90-day follow |
| All-cause mortality | The proportion of patients who die from any cause within 90-days. | 90-day follow |
| Coronary artery bypass grafting (CABG) | The rate of patients who undergo coronary artery bypass surgery (CABG) within 90-days following OMI treatment. | 90-day follow |
| Heart failure admission | The rate of hospital admissions for heart failure within 90-days following OMI treatment. | 90-day follow |
| Re-hospitalization (from any cause) | The rate of readmission to the hospital within 90-days of discharge. | 90-day follow |
The number of patients who received a procedure with vascular complications.
| From the start of the emergency visit to the following 48 hours. |
| Contrast-induced acute kidney injury | The number of patients who received a procedure with contrast-induced acute kidney injury. | 90-day follow |
| Procedure related mortality | The proportion of patients who die due to the procedure within 90 days. | 90-day follow |
| In-hospital major bleeding | The incidence of in-hospital major bleeding events occurring within 90-days of treatment. | 90-day follow |
| Major bleeding | The incidence of major bleeding events occurring within 90-days of treatment. | 90-day follow |
| Taipei Municipal Wanfang Hospital | Recruiting | Taipei | 114 | Taiwan |
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| Tri-Service General Hospital | Recruiting | Taipei | 114 | Taiwan |
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