There is an application for that

In acute and chronic stroke management, smartphone apps improve communication between first responders and on-call hospital staff and reduce door-to-needle time, according to a review of the literature.

Doctor Fabio Pilato

“In clinical practice, guideline-driven patient care is very important for improving diagnosis and outcomes, and apps provide a very convenient and easy way to check available guidelines,” said lead author Fabio Pilato. , MD, neurologist at the Università Campus Bio-Medico in Rome, Italy, said Medscape Medical New.

The review was published on September 30 in the Stroke Diary.

Literature paper

“My colleagues and I wanted to find out if smartphone apps, in addition to facilitating communication between doctors and their patients, could improve patient care,” Pilato said. “We wanted to see if there were any apps that could guide clinical decisions according to guidelines and if any were used in acute stroke management,” he added.

The researchers looked at 43 studies of stroke-related mobile phone apps designed for the clinical management of stroke between June 1, 2007, when the first iPhone was introduced, and January 31, 2022.

Apps were categorized into the following three groups, based on their purpose: primary prevention apps, acute stroke management apps, and post-acute stroke apps.

Prevention and management

Investigators found a primary prevention app, the Stroke Riskometer, based on an algorithm derived from the Framingham Stroke Risk Score and designed to educate patients about diet, physical activity and the warning signs of stroke. a stroke. However, their review did not show that the app was beneficial over standard cardiovascular risk reduction.

According to the researchers, the apps seemed to facilitate the management of acute strokes. Pre-hospital apps, such as iLAMA, Smartphone-Assisted Pre-Hospital Medical Information System, FAST-ED, Egyptian Stroke Network, Act Fast, and Mayo Clinic Acute Stroke Evaluation app accelerate stroke recognition, activate emergency medical services faster. transport to hospital and facilitate communication with stroke teams in the hospital. All of these pre-hospital applications have reduced door-to-needle time.

The JOIN app has also been shown to significantly reduce gate-to-needle time, compared to no app support, in several studies. JOIN consists of a chat, a DICOM viewer and an encrypted two-way video system for practitioner-to-practitioner video calls, as well as a milestone timestamp to record every step from home to hospital transport until the start of treatment.

StopStroke, another application that focuses on instant communication between doctors and enables real-time sharing of clinical data of stroke patients, reduces door-to-image and door-to-needle time, compared to the lack of application.

Act Fast, which uses a National Institutes of Health Stroke Scale (NIHSS) calculator, thrombolysis checklist and toolkit to share images and notes among practitioners involved in the decision-making process, reduced door-to-needle time of 16 minutes, compared to no application.

In a study of medical residents, adherence to guidelines was higher among participants who used the Mayo Clinic Acute Stroke Assessment app, compared to those who did not. Door-to-needle time was also reduced by 16 minutes in the app-assisted group, compared to controls.

Post-Acute Stroke Applications

The Rehabilitation Guardian app, consisting of health reminder, consultation, health information and patient diary, gives medical information and offers rehabilitation exercises. Patients can enter their clinical information, and medical staff can access it and assist in the rehabilitation process remotely.

When it comes to chronic management and secondary prevention apps, Pilato and colleagues found that the PRESTRO app, which combines motivational support for a healthy lifestyle and tells patients to take their medications and measure their blood pressure was successful in getting patients to be more physically active, compared to those who did not use the app.

Another secondary prevention app, the Korea University Health Monitoring System for Stroke (KUHMS2), lowers blood pressure and blood sugar in patients who use it, compared to those who don’t.

Lose It, a weight loss app, is an electronic food diary that shows the macronutrient values ​​of the foods the patient consumes, along with a daily calorie count. The Engaging Everyday Activities (EEA) app effectively reminds patients who have had transient ischemic attacks of daily activities that can reduce their risk of a recurrent attack.

Movies4Stroke offers educational videos on first aid, rehabilitation, how to improve swallowing and stroke risk factors.

AFib 2gether allows patients to enter their clinical data and calculates their annual stroke risk scores. The information is provided to a health care provider before the next visit to help the patient make an informed decision about anticoagulant therapy.

“We believe that the widespread use of smartphones and apps can improve patient care in all regions of the world, and especially in regions where consultation of updated guidelines is not readily available. However, in our study, we found that the applications to implement the guidelines by a clinical decision support system are still lacking, and we hope that these applications will increase in the future,” Pilato said.

No panacea

Commenting on this review for medical landscapeAmy Guzik, MD, associate professor of neurology at Wake Forest University School of Medicine in Winston-Salem, North Carolina, said all physicians are looking for opportunities to use technology, especially in cases of stroke, to diagnose and treat patients in the best way. they can.

Dr. Amy Guzik

“Finding ways to increase efficiency and get the message out to our patients is very important to us and that’s probably why there are so many apps out there,” said Guzik, who is also spokesperson for the American Academy of Neurology.

“These apps could be especially useful in some ways. One of them is in remote hospitals that may not have a neurologist. Helping with diagnosis and determining what a bad stroke needs to be treated at a higher level of medical care, or if it’s something the local hospital could take care of, would be helpful,” Guzik said.

“Also helping the EMS figure out which hospital to go to, or once they’re on their way, being able to talk to the neurologist or the neurosurgeon or the ER doctor and make a plan before the patient arrives, so that we can expedite care when the patient arrives, which is where apps can be particularly helpful,” she added.

There are, however, limits to what apps can do. In the case of stroke, patients can often have significant barriers that make it impossible for them to use apps at all, she said.

“Regardless of how they are cared for, many of our stroke patients will have issues with technology. A stroke can make texting difficult. Patients may have language difficulties, weakness, or cognitive impairment. it is therefore difficult for a technical solution to be the automatic solution, unless things are done in a thoughtful way to ensure that it is suitable for stroke patients.

“Additionally, there are a lot of older patients who aren’t necessarily the most tech-savvy and don’t have as much digital literacy as younger patients. Another limitation to consider is that some people may even not having easy access to technology. We have to make sure that all of this is done with fairness in mind,” Guzik said.

The study was funded by the Associazione Nazionale fra le Imprese Assicuratrici (ANIA). Pilato and Guzik did not report any relevant financial relationship.

Stroke Diary. Published online September 30, 2022. Full text.

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