title: Telecardiology improves quality of diagnosis and reduces delay to treatment in elderly patients with acute myocardial infarction and atypical presentation.
abstract: OBJECTIVE
  To assess whether telemedicine technology applied to public emergency healthcare system improves overall quality of home diagnosis in case of acute myocardial infarction among elderly patients, often characterized by higher rates of atypical presentation.
  
  
  METHODS
  About 27 841 patients from Apulia (Italy) who called public emergency healthcare number '118' underwent home ECG evaluation. Data were transmitted with a mobile telephone support to a telecardiology 'hub' active continuously (24/7). Data from elderly patients (>70 years) were compared with younger ones.
  
  
  RESULTS
  Thirty-nine percent of patients complained of chest (or epigastric) pain; ST elevation acute myocardial infarction (STEMI) was diagnosed in 1.9% of patients enrolled; 50.2% of patients with STEMI were above 70 years of age. Among STEMI patients older than 70 years, atypical presentation was detected in 32% [95% confidence interval (CI): 26.8-38.1] of patients (vs. 11% 95% CI: 7.8-15.5, P<0.001). Rate of atypical STEMI presentation, immediately diagnosed, thanks to telecardiology, rose up from 9.2% (95% CI: 5-17%) in the class of age 60-69 years to 25.6% (95% CI: 20-35%) in the class of age 70-79 years, to 35.2% (95% CI: 26-45%) in the class 80-89, and to 46.1% (95% CI: 26-67%) in the class greater than 89 years of age (P<0.01 in all cases). Number needed to treat (to avoid a single missed STEMI diagnosis) was 9.4 (95% CI: 6.4-12.9) for patients younger than 70 years versus 3.1 (95% CI: 2.6-3.7) among those older than 70 years (P<0.001).
  
  
  CONCLUSIONS
  Telecardiology home ECG diagnosis could significantly help in avoiding errors and delay in STEMI diagnosis in elderly patients.
authors: Cardiology Department, University of Foggia, Foggia, Italy. nd.brunetti@unifg.it
authors: Natale Daniele
authors: ND
authors: Brunetti
authors: Luisa
authors: L
authors: De Gennaro
authors: Gianfranco
authors: G
authors: Amodio
authors: Giulia
authors: G
authors: Dellegrottaglie
authors: Pier Luigi
authors: PL
authors: Pellegrino
authors: Matteo
authors: M
authors: Di Biase
authors: Gianfranco
authors: G
authors: Antonelli
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000787:Angina Pectoris / Q000209:etiology; D002309:Cardiology; D016009:Chi-Square Distribution; D057210:Delayed Diagnosis / Q000517:prevention & control; D004562:Electrocardiography; D004632:Emergency Medical Services; D005260:Female; D006297:Health Services Accessibility; D006299:Health Services for the Aged; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D009313:National Health Programs; D010348:Patient Care Team; D011237:Predictive Value of Tests; D017150:Public Sector; D011787:Quality of Health Care; D012815:Signal Processing, Computer-Assisted; D017216:Telemedicine; D013997:Time Factors