Cardiovascular emergencies in primary care: an observational retrospective study of a large-scale telecardiology service

Abstract

BACKGROUND: Electrocardiograms (ECGs) are an essential examination for identification and management of cardiovascular emergencies. The aim of this study was to report on the frequency and recognition of cardiovascular emergencies in primary care units. DESIGN AND SETTING: Observational retrospective study assessing consecutive patients whose digital ECGs were sent for analysis to the team of the Telehealth Network of Minas Gerais. METHODS: Data from patients diagnosed with cardiological emergencies in the primary care setting of 750 municipalities in Minas Gerais, Brazil, between March and September 2015, were collected via telephone contact with the healthcare practitioner who performed the ECG. After collection, the data were subjected to statistical analysis. RESULTS: Over the study period, 304 patients with cardiovascular emergencies were diagnosed within primary care. Only 73.4% of these were recognized by the local physicians. Overall, the most frequent ECG abnormalities were acute ischemic patterns (44.7%) and the frequency of such patterns was higher among the ECGs assigned as emergency priority (P = 0.03). It was possible to obtain complete information on 231 patients (75.9%). Among these, the mean age was 65 ± 14.4 years, 57.1% were men and the most prevalent comorbidity was hypertension (68.4%). In total, 77.9% were referred to a unit caring for cases of higher complexity and 11.7% of the patients died. CONCLUSION: In this study, cardiovascular emergencies were misdiagnosed in primary care settings, acute myocardial ischemia was the most frequent emergency and the mortality rate was high.

Estatística Cardiovascular – Brasil 2021

“…231 • Os centros de telessaúde no Brasil forneceram informação sobre a prevalência de FA e flutter atrial com base em ECG da atenção primária. [232][233][234][235] No conjunto de dados sobre ECG do sistema de telessaúde de Minas Gerais, que incluiu 1.558.421 indivíduos (idade média, 51±18 anos; 40,2% homens) com ECG realizado entre 2010 e 2017, a prevalência de FA foi 1,33%, maior em homens (1,81% vs. 1,02%) e aumentando com a idade (OR 1,08, CI 95% 1,08-1,08), chegando a 7,0% nos octogenários (8,4% em homens vs. 5,9% em mulheres). 236 • Dados de 676.621 ECG (idade média, 51±19 anos; 57,5% mulheres) realizados de 2009 a 2016 foram analisados no serviço de telemedicina da Universidade Federal de São Paulo, revelando uma prevalência de FA em 7 anos de 2,2% e uma prevalência de FA projetada para 2025 no Brasil de 1,7%.…”

Telemedicine in cardiology – prospects, risks and health inequalities

“…Research conducted in Brazil allowed detection of 304 sudden heart rhythm disorders based on data obtained using remote ECG [11]. In the study by Marcolino et al, the ECG tests were recorded in primary care clinics and with additional information about patients and forwarded to the Telehealth Network of Minas Gerais -a public telemedical service where the records were interpreted by the consultants' cardiologists.…”

“…It was revealed that in the case of uncertainty of clinical tests and symptoms interpretation, the records should be analysed by specialists. Otherwise, wrong diagnoses made by primary care doctors (29% of cases in Brazilian research) could lead to delays in treatment [11].…”

Avaliação Da Estrutura Na Atenção Primária Em Saúde Para O Suporte Básico De Vida

“…Para que estas ações sejam realizadas com qualidade e eficiência, os profissionais de saúde devem ser capazes de reconhecer a ocorrência da PCR, iniciar rapidamente o SBV e, posteriormente, encaminhar o paciente para um serviço de maior complexidade onde serão realizadas todas as ações referentes ao Suporte Avançado de Vida (SAV ) 4,[6][7] .…”