ArticleBMJ open2022
Real-world, feasibility study to investigate the use of a multidisciplinary app (Pulsara) to improve prehospital communication and timelines for acute stroke/STEMI care.
Article in BMJ open, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 1 of them a synthesis that pooled it.
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Who cites it
9 citing papers in PubMed, 1 synthesis or guideline pooled it, 15 citations in OpenAlex.
- Impact of Smartphone Apps on Reperfusion Times and Clinical Outcomes in Acute ST-Segment Elevation Myocardial Infarction: Systematic Review and Meta-Analysis.JMIR mHealth and uHealth · 2025Pooled it
- A Novel Mobile Health Software Platform to Improve Emergency Medical Systems: 912Rwanda.Research square · 2026Article
- Acute coronary occlusion among cancelled STEMI alerts: a prospective study in a telemedicine-guided network.European heart journal. Digital health · 2026Article
- Improving the management of acute myocardial infarctions: There's an App for that.American heart journal plus : cardiology research and practice · 2026Article
- Reducing Door-to-Balloon Time Using EMS-Initiated App-Based Communication.Journal of the Society for Cardiovascular Angiography & Interventions · 2024Article
- Management and prevention of in-hospital cardiac arrest: present and future.NPJ cardiovascular health · 2024Review
- Learning together for better health using an evidence-based Learning Health System framework: a case study in stroke.BMC medicine · 2024Article
- Centennial Collection: Prehospital Stroke Triage.Stroke (Hoboken, N.J.) · 2024Article
- Prehospital stroke management and mobile stroke units.Current opinion in neurology · 2023Review
Corrections and comments
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Authors and funding
23 authors at 7 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesTo determine if a digital communication app improves care timelines for patients with suspected acute stroke/ST-elevation myocardial infarction (STEMI).
designReal-world feasibility study, quasi-experimental design.
settingPrehospital (25 Ambulance Victoria branches) and within-hospital (2 hospitals) in regional Victoria, Australia.
participantsParamedics or emergency department (ED) clinicians identified patients with suspected acute stroke (onset <4.5 hours; n=604) or STEMI (n=247).
interventionThe Pulsara communication app provides secure, two-way, real-time communication. Assessment and treatment times were recorded for 12 months (May 2017-April 2018), with timelines compared between 'Pulsara initiated' (Pulsara) and 'not initiated' (no Pulsara). PRIMARY OUTCOME MEASURE: Door-to-treatment (needle for stroke, balloon for STEMI) Secondary outcome measures: ambulance and hospital processes.
resultsStroke (no Pulsara n=215, Pulsara n=389) and STEMI (no Pulsara n=76, Pulsara n=171) groups were of similar age and sex (stroke: 76 vs 75 years; both groups 50% male; STEMI: 66 vs 63 years; 68% and 72% male). When Pulsara was used, patients were off ambulance stretcher faster for stroke (11(7, 17) vs 19(11, 29); p=0.0001) and STEMI (14(7, 23) vs 19(10, 32); p=0.0014). ED door-to-first medical review was faster (6(2, 14) vs 23(8, 67); p=0.0001) for stroke but only by 1 min for STEMI (3 (0, 7) vs 4 (0, 14); p=0.25). Door-to-CT times were 44 min faster (27(18, 44) vs 71(43, 147); p=0.0001) for stroke, and percutaneous intervention door-to-balloon times improved by 17 min, but non-significant (56 (34, 88) vs 73 (49, 110); p=0.41) for STEMI. There were improvements in the proportions of patients treated within 60 min for stroke (12%-26%, p=0.15) and 90 min for STEMI (50%-78%, p=0.20).
conclusionsIn this Australian-first study, uptake of the digital communication app was strong, patient-centred care timelines improved, although door-to-treatment times remained similar.
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