Telecardiology community: a new approach to take care of cardiac patients. "Boario Home-Care" Investigators.
BACKGROUND
Cardiovascular diseases are the leading cause of morbidity and mortality in Western countries and represent, in terms of diagnostic and treatment measures, a large amount of health care expenses. A telecardiology service may offer to general practitioners, in real time, a useful diagnostic tool and the possibility of an accurate screening of patients with suspected ischemic heart disease.


METHODS
From February to July 1998, in the provinces of Bergamo and Brescia (Italy), 178 general practitioners received a portable Card Guard 7100 electrocardiographer transferring, by a mobile or fixed telephone, a 12 lead ECG to a receiving station, where a cardiologist was available for the reporting and interactive teleconsultation.


RESULTS
During the first 6 months a total 2800 calls took place. Due to incompleteness of requested data only 2254 traces, corresponding to 2254 subjects (mean age 63 +/- 18 years) were entered in the study. In 27% of patients (n = 609) there was a history of systemic hypertension, in 12.5% (n = 283) there was a history of coronary artery disease, and in 38% (n = 834) there was no history of cardiovascular diseases. At the time of ECG recording, 42% of patients (n = 949) were symptomatic: more common symptoms were chest pain (39%), dyspnea (23%), palpitation (19%), dizziness or faint (10%), and asthenia (9%). No action was suggested by cardiologists in 74% of cases. Of the remaining patients, 16% (n = 92) were referred to the Emergency Department, 27% (n = 158) were offered further diagnostic tests as an out patient, and 56% (n = 328) were started on medication or had their treatment changed.


CONCLUSIONS
A telecardiology system provides a useful support to general practitioners in the management, in real time, of patients with cardiovascular conditions, and possibly contributes to optimization of health care costs in terms of appropriateness of hospital admissions and diagnostic tests.
Scalvini
S
S
Divisione di Cardiologia, Fondazione Salvatore Maugeri, IRCCS, Gussago (BS), Ospedale di Vallecamonica, Esine, BS.
Zanelli
E
E
Domenighini
D
D
Massarelli
G
G
Zampini
P
P
Giordano
A
A
Glisenti
F
F
D000368:Aged; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000191:economics / Q000401:mortality / Q000628:therapy; D003327:Coronary Disease / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007558:Italy; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D017216:Telemedicine / Q000191:economics