The TeleGuard trial of additional telemedicine care in CAD patients. 1 Utilization of the system.
Patients with established coronary artery disease (CAD) were recruited in 11 hospitals and randomized to an intervention (telemedicine system; n = 752) or a control group (usual medical care; n = 748). On the day before discharge, patients in the intervention group were equipped with a 12-lead event recorder and trained to use the device. Whenever they had symptoms, they could contact the call centre, transmit an ECG (without redialling) and consult a physician. During a 12-month study, 171 patients (23%) in the intervention group contacted the call centre, a total of 269 times. The main reasons for calling were chest pain and radiating pain. Pathological changes were seen in 24% of the transmitted ECGs. Only 23% of the calls were made in the first hour after onset of symptoms and a further 12% in the subsequent hour, suggesting that patients should be encouraged to use ECG transmission at an earlier stage. At follow-up, 157 patients (21%) had had at least one recurrent cardiac event (myocardial infarction, cardiac hospital stay, re-vascularization). The proportion was significantly higher in telemedicine users (35%) than in non-users (17%), P < 0.001. Regardless of utilization, the majority of the intervention patients considered that the telemedicine system was helpful (users = 93%, non-users = 89%; P = 0.095).
Katalinic
Alexander
A
Institute for Social Medicine, University of Luebeck, Luebeck, Germany.
Waldmann
Annika
A
Schwaab
Bernhard
B
Richardt
Gert
G
Sheikhzadeh
Abdolhamid
A
Raspe
Heiner
H
D000328:Adult; D002637:Chest Pain / Q000175:diagnosis* / Q000523:psychology; D003324:Coronary Artery Disease / Q000150:complications*; D003695:Delivery of Health Care; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000517:prevention & control; D017060:Patient Satisfaction; D011788:Quality of Life / Q000523:psychology; D019114:Remote Consultation; D017216:Telemedicine / Q000706:statistics & numerical data; D016896:Treatment Outcome