Abstract
Background: Coronary artery disease (CAD) is a major public health concern globally, including in
Thailand. Access to coronary angiography (CAG) and percutaneous coronary intervention (PCI) is
important for CAD patients, especially those with acute coronary syndromes (ACS). Delays in
accessing cardiology consultation and CAG/PCI have been observed for both ACS and chronic
coronary syndrome (CCS) patients.
Methods: This participatory action research involved a multidisciplinary team, including physicians,
cardiologists, nurses, medical records staff, and administrators from the Bangkok Metropolitan
Administration Medical Office. The team identified challenges and collaboratively developed the
"Seamless Bangkok Heart Network," a cloud-based health information exchange (HIE) system for
referral and consultation of CAD patients. The network connects Taksin Hospital (hub) with five
other hospitals (spokes) and the Bangkok emergency medical service center (Erawan center).
Patient data was securely exchanged, enabling timely referrals. The study compared conventional
referrals with referrals through the Seamless Bangkok Heart Network using cluster randomization,
assessing time-to-CAG/PCI for ACS and CCS patients.
Results: Key challenges identified included incomplete clinical information, data security concerns
with social media platforms, and limited bed capacity at the hub hospital. For CCS patients,
multiple visits to Taksin Hospital were often required before CAG/PCI, causing delays and
inconvenience. From October 2024 to January 2025, 32 patients were enrolled (25 in the Seamless
Bangkok Heart Network group, 7 in the conventional referral group). The mean age was 63.8±3.2
years and 64.1±4.1 years, respectively, with 60% and 71.4% males. ACS prevalence was 60% and
100%. For STEMI, diagnosis-to-wire crossing within 120 minutes was achieved in 66.6% and 40% of
cases, respectively (p=0.46). For NSTE-ACS, CAG/PCI within 72 hours was 75% and 100%,respectively
(p=0.64). For CCS, CAG/PCI within 90 days was 90% in the Seamless Bangkok Heart Network group;
no CCS patients were referred conventionally.
Conclusion: The Seamless Bangkok Heart Network showed a trend towards improved timely
access to CAG/PCI, particularly for STEMI patients. However, the limited sample size and study
duration restricted statistical analysis. Further research with a larger sample size is needed to
confirm these findings.
