title: Hot spot: impact of July 2011 heat wave in southern Italy (Apulia) on cardiovascular disease assessed by emergency medical service and telemedicine support.
abstract: BACKGROUND
  Heat waves have been reported as being associated with increased rates of hospitalizations and deaths.
  
  
  METHODS
  In July 2011, a heat wave hit southern Italy. We enrolled 9,282 consecutive patients who called the Apulia (southeastern Italy) regional free public emergency medical service (EMS) "118" number (out of 4 million inhabitants) during July 2011. All patients were evaluated with a prehospital electrocardiogram (ECG) thanks to telecardiology support provided by a single telemedicine hub. Local temperatures and relative humidity were recorded and combined in order to calculate the heat index (HI), a more accurate parameter to assess perceived discomfort caused by hot temperatures.
  
  
  RESULTS
  The mean number of calls to the telecardiology hub for prehospital ECG screening in the case of suspected heart disease was increased 48 h after days with an HI ≥ 44 (402 ± 68 versus 275 ± 52, p<0.001, +46%), when the number of calls was directly related to HI values (p < 0.01). ECG diagnoses of new-onset atrial fibrillation were significantly increased 24 h after days with an HI ≥ 44 (12 ± 7 versus 8 ± 3, p<0.01, +50%). ECG diagnoses of ST-elevation acute myocardial infarction, in contrast, remained substantially unchanged. No significant gender or age (>70 versus <70 years) differences were observed (chi-squared p not significant); increased rates of EMS callings were found 48 h after days with an HI ≥ 44 in hypertensive patients (131 ± 42 versus 78 ± 26, p<0.001, +68%) and subjects with prior cardiovascular disease (137 ± 43 versus 89 ± 22, p<0.001, +54%).
  
  
  CONCLUSIONS
  Increased work burden for EMS assessed with prehospital telecardiology screening accompanies heat waves because of subjects calling for suspected acute heart disease. Prehospital screening with telecardiology support may be of help in identifying subjects who do not require hospitalization in the event of heat waves with increased calls to EMS.
authors.affiliation: 1 Department of Cardiology, University of Foggia , Foggia, Italy .
authors.forename: Natale Daniele
authors.initials: ND
authors.lastname: Brunetti
authors.forename: Daniele
authors.initials: D
authors.lastname: Amoruso
authors.forename: Luisa
authors.initials: L
authors.lastname: De Gennaro
authors.forename: Giulia
authors.initials: G
authors.lastname: Dellegrottaglie
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Di Giuseppe
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Antonelli
authors.forename: Matteo
authors.initials: M
authors.lastname: Di Biase
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D004632:Emergency Medical Services; D055874:Extreme Heat / Q000009:adverse effects*; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D017216:Telemedicine