title: Telecardiology applied to a region-wide public emergency health-care service.
abstract: 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.
authors.affiliation: Cardiology Department, University of Foggia, Foggia, Italy. dr.natale.daniele.brunetti@hotmail.it
authors.forename: Natale Daniele
authors.initials: ND
authors.lastname: Brunetti
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Amodio
authors.forename: Luisa
authors.initials: L
authors.lastname: De Gennaro
authors.forename: Giulia
authors.initials: G
authors.lastname: Dellegrottaglie
authors.forename: Pier Luigi
authors.initials: PL
authors.lastname: Pellegrino
authors.forename: Matteo
authors.initials: M
authors.lastname: Di Biase
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Antonelli
mesh_terms: 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*