RESUMEN
BACKGROUND: The CArdiovascular Prevention wIth Telecardiology in ApuLia (CAPITAL) study aimed to investigate the prevalence of cardiovascular risk factors, the status of cardiovascular prevention, and the compliance to international scientific societies' guidelines on cardiovascular prevention in a Mediterranean region. METHODS: The CAPITAL study was based on the assessment of cardiovascular risk and compliance to guidelines on cardiovascular prevention, and on an electrocardiogram screening with remote telemedicine support performed in pharmacies of Apulia (Italy); the study was expected to enroll 10â000 consecutive patients accessing their usual pharmacy. RESULTS: In the first 1000 patients enrolled, 16% were smokers, 9% diabetic, 26% hypertensive, 43% overweight, and 23% obese; 37% of the patients treated with antihypertensive drugs did not achieve the target levels, regardless of the number of antihypertensive drugs given, and 60% of subjects treated with lipid-lowering drugs did not achieve the target levels.Twenty-two per cent of the patients subjected to the lipid-lowering drugs did not check their cholesterol levels in the past 12 months, and 21% of those taking antihypertensive drugs did not check their blood pressure levels.Left ventricular hypertrophy was detected at electrocardiogram examination in 3.4% of the cases, and in 2.6% of the patients with unknown hypertension: 52% of the hypertensive patients were not checked with an electrocardiogram in the past 12 months, 44% of the diabetic patients, and 44% of subjects treated with lipid-lowering drugs. CONCLUSIONS: The awareness, therapy, and control of cardiovascular risk factors in a Mediterranean real-world population are unsatisfactory. There is a large scope of an improvement in the control of cardiovascular risk factors. Telemedicine support and pharmacy-based assessment may be helpful in implementing strategies aimed at the improvement of cardiovascular prevention.
Asunto(s)
Hipertensión/tratamiento farmacológico , Hipertensión/epidemiología , Cumplimiento de la Medicación/estadística & datos numéricos , Telemedicina , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Antihipertensivos/uso terapéutico , Diabetes Mellitus/epidemiología , Electrocardiografía , Femenino , Conocimientos, Actitudes y Práctica en Salud , Promoción de la Salud , Humanos , Hipertrofia Ventricular Izquierda/epidemiología , Hipolipemiantes/uso terapéutico , Italia/epidemiología , Masculino , Persona de Mediana Edad , Análisis Multivariante , Sobrepeso/epidemiología , Análisis de Regresión , Factores de RiesgoAsunto(s)
Servicios Médicos de Urgencia/estadística & datos numéricos , Gripe Humana/prevención & control , Vacunación Masiva/estadística & datos numéricos , Aceptación de la Atención de Salud/estadística & datos numéricos , Estaciones del Año , Telemedicina , Enfermedad Aguda , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/etiología , Enfermedades Cardiovasculares/terapia , Humanos , Gripe Humana/complicaciones , Italia/epidemiologíaAsunto(s)
Angioplastia Coronaria con Balón/métodos , Electrocardiografía/métodos , Servicios Médicos de Urgencia/métodos , Infarto del Miocardio/mortalidad , Sistema de Registros , Telemedicina/métodos , Triaje/métodos , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/diagnóstico , Infarto del Miocardio/terapia , Tasa de Supervivencia/tendencias , Estados Unidos/epidemiologíaAsunto(s)
Cardiología/métodos , Enfermedades Cardiovasculares/terapia , Atención de Enfermería/métodos , Médicos , Telemedicina/métodos , Anciano , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/epidemiología , Enfermedad Crónica , Estudios de Cohortes , Electrocardiografía Ambulatoria/métodos , Femenino , Humanos , Italia/epidemiología , Masculino , Manejo de Atención al Paciente/métodos , Informe de InvestigaciónRESUMEN
BACKGROUND: We report the preliminary data from a regional registry on ST-elevation myocardial infarction (STEMI) patients treated with primary angioplasty in Apulia, Italy; the region is covered by a single public health-care service, a single public emergency medical service (EMS), and a single tele-medicine service provider. METHODS: Two hundred and ninety-seven consecutive patients with STEMI transferred by regional free public EMS 1-1-8 for primary-PCI were enrolled in the study; 123 underwent pre-hospital electrocardiograms (ECGs) triage by tele-cardiology support and directly referred for primary-PCI, those remaining were just transferred by 1-1-8 ambulances for primary percutaneous coronary intervention (PCI) (diagnosis not based on tele-medicine ECG; already hospitalised patients, emergency-room without tele-medicine support). Time from first ECG diagnostic for STEMI to balloon was recorded; a time-to-balloon <1 h was considered as optimal and patients as timely treated. RESULTS: Mean time-to-balloon with pre-hospital triage and tele-cardiology ECG was significantly shorter (0:41 ± 0:17 vs 1:34 ± 1:11 h, p<0.001, -0:53 h, -56%) and rates of patients timely treated higher (85% vs 35%, p<0.001, +141%), both in patients from the 'inner' zone closer to PCI catheterisation laboratories (0:34 ± 0:13 vs 0:54 ± 0:30 h, p<0.001; 96% vs 77%, p<0.01, +30%) and in the 'outer' zone (0:52 ± 0:17 vs 1:41 ± 1:14 h, p<0.001; 69% vs 29%, p<0.001, +138%). Results remained significant even after multivariable analysis (odds ratio for time-to-balloon 0.71, 95% confidence interval (CI) 0.63-0.80, p<0.001; 1.39, 95% CI 1.25-1.55, p<0.001, for timely primary-PCI). CONCLUSIONS: Pre-hospital triage with tele-cardiology ECG in an EMS registry from an area with more than one and a half million inhabitants was associated with shorter time-to-balloon and higher rates of timely treated patients, even in 'rural' areas.
Asunto(s)
Infarto del Miocardio/terapia , Telemedicina/métodos , Triaje/métodos , Anciano , Angioplastia Coronaria con Balón/estadística & datos numéricos , Electrocardiografía/métodos , Femenino , Humanos , Italia , Masculino , Análisis Multivariante , Intervención Coronaria Percutánea/estadística & datos numéricos , Sistema de Registros , Características de la Residencia/estadística & datos numéricos , Estudios Retrospectivos , Salud Rural , Tiempo de Tratamiento/estadística & datos numéricosRESUMEN
BACKGROUND: Heat waves have been reported as being associated with increased rates of hospitalizations and deaths. MATERIALS AND 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.
Asunto(s)
Enfermedades Cardiovasculares/epidemiología , Servicios Médicos de Urgencia , Calor Extremo/efectos adversos , Telemedicina , Adulto , Anciano , Enfermedades Cardiovasculares/etiología , Enfermedades Cardiovasculares/mortalidad , Femenino , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/etiología , Humanos , Italia/epidemiología , Masculino , Persona de Mediana EdadRESUMEN
BACKGROUND: Telemedicine has been shown to improve quality of health-care delivery in several fields of medicine; its cost-effectiveness, however, is still a matter of debate. HYPOTHESIS: Pre-hospital telemedicine electrocardiogram triage for regional public emergency medical service may reduce costs. METHODS: An economic evaluation (cost analysis) was performed from the perspective of regional health-care system. Patients enrolled in the study and considered for cost analysis were those who called the local emergency medical service (EMS; dialing 1-1-8) during 2012 and underwent prehospital field triage with a telemedicine electrocardiogram (ECG) in the case of suspected acute cardiac disease (acute coronary syndrome, arrhythmia). The prehospital ECGs were read by a remote cardiologist, available 24/7. Cost savings associated with this method were calculated by subtracting the cost of prehospital triage with telemedicine support from the cost of conventional emergency department triage (ECG and consultation by a cardiologist). RESULTS: During 2012, the regional EMS performed 109 750 ECGs by telemedicine support. The associated total cost for the regional health-care system was 1 833 333, with a 16.70 cost per single ECG/consultation. Given the cost of similar conventional emergency department treatment from a regional rate list of 24.80 to 55.20, the savings was 8.10 to 38.40 per ECG/consultation (total savings, 891 759.50 to 4 219 379.50). The cost for ruling out an acute cardiac disease was 25.30; for a prehospital diagnosis of cardiovascular disease, 49.20. With 629 prehospital diagnoses of ST-elevation myocardial infarction and reported reductions in mortality thanks to prehospital diagnosis deduced from prior studies, 69 lives per year presumably could be saved, with a cost per quality-adjusted life year gained of 1927, 990/ - 2508 after correction for potential savings. CONCLUSIONS: Prehospital EMS triage with telemedicine ECG in patients with suspected acute cardiac disease may reduce health-care costs.
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Electrocardiografía/economía , Servicios Médicos de Urgencia/economía , Telemetría/economía , Triaje/métodos , Análisis Costo-Beneficio , Costos y Análisis de Costo , Servicio de Urgencia en Hospital/economía , Cardiopatías/diagnóstico , Humanos , Italia/epidemiología , Infarto del Miocardio/diagnóstico , Años de Vida Ajustados por Calidad de Vida , Programas Médicos Regionales/economía , Triaje/economíaAsunto(s)
Cardiología , Electrocardiografía , Cardiopatías/diagnóstico , Prisiones , Telemedicina , Urgencias Médicas , Estudios de Factibilidad , Femenino , Humanos , Italia , MasculinoAsunto(s)
Ejercicio Físico/fisiología , Docentes , Obesidad/fisiopatología , Obesidad/terapia , Instituciones Académicas , Telemedicina/métodos , Adolescente , Niño , Femenino , Humanos , Italia/epidemiología , Masculino , Obesidad/epidemiología , Proyectos Piloto , Circunferencia de la Cintura/fisiologíaRESUMEN
AIM: To evaluate the rate of prevalence of significant arrhythmias in emergency medical service (EMS) subjects referred for syncope and screened with pre-hospital tele-cardiology ECG. METHODS: 2648 consecutive EMS patients referred for syncope were evaluated with tele-cardiology support. Pre-hospital ECGs were sent to a single tele-cardiology "hub", active 24/7 and serving a region of 4-million inhabitants, and promptly read by a cardiologist. Prevalence of any arrhythmias or conduction disturbances was recorded. RESULTS: In more than 55% of cases ECG findings were normal; in 13% ECG showed sinus tachycardia, in 9% sinus bradycardia. Prevalence of ventricular tachycardia was 0.20%, while significant AV-disturbances were present in 1.12% of cases (0.11% second-degree type 2 AV-block, 0.11% advanced AV-block, 0.19% third-degree AV-block, 0.45% junctional rhythm, 0.26% ventricular rhythm). Limited gender differences were detectable. No significant arrhythmias were found in subjects younger than 30 years. Prevalence of several arrhythmias was age related. CONCLUSIONS: Prevalence of significant arrhythmias among EMS patients referred for syncope and evaluated with pre-hospital tele-cardiology ECG is low, and almost absent in subjects below 30 years. Tele-cardiology pre-hospital screening by a single regional "hub" may be helpful for the prompt diagnosis of arrhythmia related syncope.
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Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/epidemiología , Electrocardiografía/estadística & datos numéricos , Derivación y Consulta/estadística & datos numéricos , Síncope/diagnóstico , Síncope/epidemiología , Comorbilidad , Servicios Médicos de Urgencia , Femenino , Humanos , Italia/epidemiología , Masculino , Persona de Mediana Edad , Prevalencia , Reproducibilidad de los Resultados , Medición de Riesgo , Sensibilidad y Especificidad , TelemedicinaRESUMEN
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.
Asunto(s)
Fibrilación Atrial/diagnóstico , Electrocardiografía , Servicios Médicos de Urgencia , Telemedicina , Telemetría , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Fibrilación Atrial/complicaciones , Fibrilación Atrial/epidemiología , Teléfono Celular , Distribución de Chi-Cuadrado , Electrocardiografía/instrumentación , Femenino , Humanos , Italia/epidemiología , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Prevalencia , Pronóstico , Sensibilidad y Especificidad , Telemedicina/instrumentación , Telemetría/instrumentaciónRESUMEN
BACKGROUND: In patients with a major cardiac event, the first priority is to minimize time-to-treatment. For many patients, the first and fastest contact with the health system is through emergency medical services (EMS). However, delay to treatment is still significant in developed countries, and international guidelines therefore recommend that EMS use prehospital electrocardiogram (ECG). Many communities are implementing prehospital ECG programs, with different technical solutions. METHODS: We report on a region-wide prehospital ECG telecardiology program that involved 233,657 patients from all over Apulia (4 million inhabitants), Italy, who called the public regional free EMS telephone number "118." Prehospital ECG was transmitted by mobile phone to a single regional telecardiology "hub" where a cardiologist available 24/7 promptly reported the ECG, having a briefing with on-scene EMS personnel and EMS district central; patients were then directed to fibrinolysis or primary percutaneous coronary intervention (PCI) as appropriate. RESULTS: Patients were >70 years in 51% of cases, and 55% of prehospital ECGs were unremarkable; the remaining 45% showed signs suggesting acute coronary syndrome (ACS) in 18%, arrhythmias in 20%, and minor findings in 62%. In cases of suspected ACS (chest pain), ECG findings were normal in 77% of patients; 74% of subjects with suspected ACS were screened within 30' from the onset of symptoms. CONCLUSIONS: A regional single telecardiology hub providing prehospital ECG for a sole regional public EMS provides an example of a prehospital ECG network optimizing quality of ECG report and uniformity of EMS assistance in a large region-wide network.
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Servicios Médicos de Urgencia/métodos , Infarto del Miocardio/diagnóstico , Telemedicina/instrumentación , Adolescente , Anciano , Anciano de 80 o más Años , Teléfono Celular , Electrocardiografía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/terapia , Adulto JovenAsunto(s)
Cardiología/métodos , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/prevención & control , Tamizaje Masivo/métodos , Telemedicina/métodos , Enfermedades Cardiovasculares/epidemiología , Geografía , Humanos , Región Mediterránea/epidemiología , Factores de RiesgoRESUMEN
AIM: 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). CONCLUSION: Telecardiology home ECG diagnosis could significantly help in avoiding errors and delay in STEMI diagnosis in elderly patients.
Asunto(s)
Cardiología , Electrocardiografía , Servicios Médicos de Urgencia , Servicios de Salud para Ancianos , Infarto del Miocardio/diagnóstico , Infarto del Miocardio/terapia , Calidad de la Atención de Salud , Telemedicina , Dolor Abdominal/etiología , Factores de Edad , Anciano , Anciano de 80 o más Años , Angina de Pecho/etiología , Distribución de Chi-Cuadrado , Diagnóstico Tardío/prevención & control , Femenino , Accesibilidad a los Servicios de Salud , Humanos , Italia , Masculino , Persona de Mediana Edad , Infarto del Miocardio/complicaciones , Programas Nacionales de Salud , Grupo de Atención al Paciente , Valor Predictivo de las Pruebas , Sector Público , Procesamiento de Señales Asistido por Computador , Factores de TiempoRESUMEN
AIM: 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.