Telecardiology applied to a region-wide public emergency health-care service.
OBJECTIVE
To assess feasibility and reliability of telecardiology technologies applied to a region-wide public emergency health-care service.


METHODS
About 27,841 patients from all over Apulia (19.362 km(2), 4 million inhabitants) were referred from October 2004 until April 2006 to public emergency health-care number "118" and underwent ECG evaluation according to a previously fixed inclusion protocol. Data recorded were transmitted with mobile telephone support to a telecardiology "hub" active 24-h a day. Hospitalization or further examinations were arranged by emergency physicians on the basis of ECG diagnosis and consultation.


RESULTS
Thirty-nine percent of patients complained of chest pain (CP) or epigastric pain, 26% loss of consciousness, 10% breathlessness, and 7% palpitations. Atrial fibrillation (AF) was diagnosed in 11.68% of patients and ST-elevation acute myocardial infarction (STEMI) in 1.91%. Among patients with CP, ECG showed STEMI in only 3.84% of cases, theoretically eligible for fibrinolysis or primary PCI; patients with STEMI complained of CP in 78.94% of cases. Of the patients, 65.28% with STEMI were from small towns without coronary care units, thus benefiting from an immediate pre-hospital diagnosis. Among patients with palpitations, only 10.27% of subjects showed ECG signs of supra-ventricular tachycardia and 25.18% of AF; other subjects avoided further improper hospitalization or emergency department monitoring.


CONCLUSIONS
This first region-wide leading experience shows the feasibility and reliability of telecardiology applied to a public emergency health-care service. Telemedicine protocols would probably be useful in lowering the number of improper hospitalizations and shortening delay in the diagnosis process of some heart diseases.
Brunetti
Natale Daniele
ND
Cardiology Department, University of Foggia, Foggia, Italy. dr.natale.daniele.brunetti@hotmail.it
Amodio
Gianfranco
G
De Gennaro
Luisa
L
Dellegrottaglie
Giulia
G
Pellegrino
Pier Luigi
PL
Di Biase
Matteo
M
Antonelli
Gianfranco
G
D002309:Cardiology / Q000295:instrumentation* / Q000379:methods*; D004562:Electrocardiography / Q000295:instrumentation / Q000379:methods; D004632:Emergency Medical Services / Q000379:methods*; D006331:Heart Diseases / Q000175:diagnosis / Q000628:therapy; D006760:Hospitalization; D006801:Humans; D007558:Italy; D012189:Retrospective Studies; D017216:Telemedicine / Q000295:instrumentation* / Q000379:methods*