[Telemedical monitoring of electrocardiograms after cardiac surgery--results from a pilot study among 208 patients].
BACKGROUND
An increasing number of older patients undergo cardiac surgery. Complications after cardiac surgery such as rhythm disorders, myocardial infarction and atypical symptoms frequently lead to ambulatory visits and hospitalisations. Telemonitoring might be one method for rapid and efficient detection and classification of symptoms. We examined in this pilot study if ECG-telemonitoring after cardiac surgery proves to be an useful, reliable and accepted procedure with respect to cost and risk reduction.


RESULTS
Two hundred eight patients (46 female, 162 male) received after surgery an individually adjusted portable 12-lead ECG-monitor. Within three months all incoming ECG-recordings were analysed. In total, 1387 calls from 165 patients (80% use) with ECG-recording (8,4 calls per patient) were collected. There were 235 calls (17%) because of symptoms, 51% of them were registered between 6 PM and 8 AM. Fourteen (6%) out of those 235 emergency calls with ECG-registration led to hospitalisation (n=5) or ambulatory visits next day. The remaining 221 ECG showed no pathological ECG-signs and the patients could be managed with telephonic advice, reassurance and telemedical follow up. Readmissions were due to angina pectoris, severe but unspecific chest pain and cardiac decompensation (n=3) as well as rhythm disturbances (n=2). Almost 75% of all emergency calls were recorded within the first 60 min after the onset of symptoms.


CONCLUSIONS
Older patients reproducibly are able to telemetrically transmit electrocardiograms after a short training before discharged home. Although there is a low incidence of complications among our study population, telemedical ECG-monitoring rapidly helps to differentiate between the symptoms leading to increased patient safety and prevented further damage. The reduction of ambulatory visits and hospitalisations only for treatment of objectified symptoms may lead to a overall cost reduction in the health care system. The reduction of unnecessary hospitalisations and ambulatory visits might also contribute to an optimised time management.
Diez
C
C
Martin-Luther-Universität Halle-Wittenberg, Klinik und Poliklinik für Herz- und Thoraxchirurgie, Ernst-Grube-Strasse 40, 06097 Halle/Saale, Germany. claudius.diez@medizin.uni-halle.de
Korb
H
H
Waehner
M
M
Silber
R-E
RE
Niemann
B
B
D000368:Aged; D000787:Angina Pectoris / Q000175:diagnosis* / Q000453:epidemiology; D001145:Arrhythmias, Cardiac / Q000175:diagnosis* / Q000453:epidemiology; D002637:Chest Pain / Q000453:epidemiology / Q000209:etiology*; D001026:Coronary Artery Bypass; D015716:Electrocardiography, Ambulatory / Q000295:instrumentation* / Q000706:statistics & numerical data; D005260:Female; D005858:Germany; D006331:Heart Diseases / Q000453:epidemiology / Q000601:surgery*; D006333:Heart Failure / Q000175:diagnosis* / Q000453:epidemiology; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data; D010865:Pilot Projects; D011183:Postoperative Complications / Q000175:diagnosis* / Q000453:epidemiology; D012017:Referral and Consultation / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D013686:Telemetry / Q000295:instrumentation* / Q000706:statistics & numerical data; D013689:Telephone / Q000706:statistics & numerical data; D014600:Utilization Review / Q000706:statistics & numerical data