title: Atrial fibrillation with symptoms other than palpitations: incremental diagnostic sensitivity with at-home tele-cardiology assessment for emergency medical service.
abstract: BACKGROUND
  Clinical presentation of atrial fibrillation (AF) is usually represented by palpitations; nevertheless, atypical presentation of AF with symptoms other than palpitations may be not uncommon in elderly patients. This study therefore aimed to evaluate incremental diagnostic value of tele-medicine at-home assessment in patients who called emergency medical service (EMS).
  
  
  METHODS
  A total of 27,841 consecutive EMS patients referred for suspected heart disease underwent ECG assessment with a mobile ECG-recorder device. ECGs were transmitted with mobile-phone support to a tele-cardiology 'hub' active 24/7 where a cardiologist read the ECGs. Rate of prevalence of AF, age of patients, and symptoms were analysed.
  
  
  RESULTS
  AF was diagnosed in 11.67% of patients who underwent ECG examination. Typical symptoms were complained by 6.56% of whole patients, only 14.05% of patients with AF: rate of subjects with AF and typical symptoms significantly decreased with age (<65 years 29.58%, 65-75 years 17.06%, >75 years 10.35%, p < 0.001). Number needed to diagnose an AF with atypical presentation (number needed to treat) decreased from 45 (<65 years) to 9 (65-75 years) and 5 (>75 years) (p < 0.001). Tele-cardiology support increased the rate of at-home diagnosis of AF from two-fold (in 40-year-olds) up to four-fold (60-year-olds) and seven-fold (70-year-olds).
  
  
  CONCLUSIONS
  AF with symptoms other than palpitations is a common finding in elderly EMS patients. Tele-cardiology support improves the sensitivity of diagnosis of AF in elderly EMS patients and is useful in at-home identification of subjects with AF and atypical presentation.
authors.affiliation: Cardiology Department, University of Foggia, Foggia, Italy.
authors.forename: Natale Daniele
authors.initials: ND
authors.lastname: Brunetti
authors.forename: Luisa
authors.initials: L
authors.lastname: De Gennaro
authors.forename: Pier Luigi
authors.initials: PL
authors.lastname: Pellegrino
authors.forename: Giulia
authors.initials: G
authors.lastname: Dellegrottaglie
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Antonelli
authors.forename: Matteo
authors.initials: M
authors.lastname: Di Biase
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D040421:Cell Phone; D016009:Chi-Square Distribution; D004562:Electrocardiography / Q000295:instrumentation; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D012680:Sensitivity and Specificity; D017216:Telemedicine / Q000295:instrumentation; D013686:Telemetry / Q000295:instrumentation