title: Transtelephonic electrocardiography for managing out-of-hospital chest pain emergencies.
abstract: BACKGROUND
  Some healthcare facilities lack professionals qualified to interpret electrocardiograms. We aimed to assess the usefulness of transtelephonic electrocardiography in combination with patients' clinical histories in the diagnosis and management of patients with acute chest pain in out-of-hospital healthcare facilities with personnel without expertise in cardiology or electrocardiography.
  
  
  METHODS
  Data from 506 consecutive patients (53.9 ± 16.2 years old) referred from 55 healthcare facilities without professionals specialized in cardiology or electrocardiography form the basis of analysis. Patients were classified into 2 groups according to the results of transtelephonic electrocardiography: (A) patients without electrocardiographic abnormalities (n = 445) and (B) patients who presented abnormalities suggesting a cardiac origin (n = 61) of the chest pain. The presence of risk factors was evaluated by multivariate analysis.
  
  
  RESULTS
  The following risk factors were independent predictors of electrocardiographic abnormalities: male gender (P = .006), diabetes mellitus (P = .0001), and dyslipidemia (P = .001). The multivariate analysis yielded a high degree of specificity (99.6%). Follow-up visits confirmed the noncardiac origin of pain in 432 patients (97%) in group A and the cardiac origin of pain in 59 patients (97%) in group B.
  
  
  CONCLUSIONS
  Transtelephonic electrocardiography combined with awareness of the risk factors of patients presenting with chest pain is useful for the diagnostic management of these patients in health care facilities without the means to interpret electrocardiograms.
authors: Department of Cardiology, University Hospital Virgen del Rocío, Seville, Spain. gbaron@jet.es
authors: Gonzalo
authors: G
authors: Barón-Esquivias
authors: Juan Jesús
authors: JJ
authors: Santana-Cabeza
authors: Roberto
authors: R
authors: Haro
authors: Antonio
authors: A
authors: Núñez
authors: Enrique
authors: E
authors: Pérez
authors: Ángel
authors: Á
authors: Martínez
authors: Antoni
authors: A
authors: Martínez-Rubio
mesh_terms: D002637:Chest Pain / Q000175:diagnosis*; D004562:Electrocardiography / Q000379:methods*; D004630:Emergencies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D013689:Telephone