Tele-ECG consulting and outcomes on primary care patients in a low-to-middle income population: The first experience from Makassar Telemedicine Program, Indonesia

Abstract

Background: Telemedicine has been a popular tool to overcome the lack access to healthcare facilities, primarily in underprevilaged populations. We aimed to describe and assess the implementation of tele-electrocardiography (ECG) program in primary care settings in Indonesia, and subsequently examine the short- and mid-term outcomes of patients those received tele-ECG consultation.Methods: A total of 505 ECG recordings from thirty primary care centers were transmitted to Makassar Cardiac Center, Indonesia from January to July 2017. We prospectively collected data by sending a detailed questionnaire to general practitioners (GPs). Follow-up was performed at 30 days and at the end of follow-up on October 2018.Results: Of 505 recordings, all (100%) ECGs were qualified for analysis, and about a half showed normal findings. Ischemia presented in 15.6%, arrhythmia in 23.6%, and abnormalities compatible with structural changes in 5.1%. The mean age of participants was 53.3 ± 13.6 years, and 40.2% were male. Most (73.9%) of these primary care patients turned up with a manifasted CVD symptom with at least one risk factor. More men had an ischemic ECG compare to women (p<0.01), while aged >55 years was associated with ischemic or arrhythmic ECG (p<0.05). Factors significantly associated with a normal ECG were younger age, female gender, lower blood pressure and heart rate, and no history of previous cardiovascular disease (CVD) or medication. More patients with an abnormal ECG had a history of hypertension, known diabetes, and were current smokers (p<0.05). Majority (95%) of GPs were satisfied with each tele-ECG consultation, and 58.6% used tele-ECG for an expert opinion. Over the total follow-up (14 ± 6.6 months), seven (1.4%) patients died and 96 (19.0%) were hospitalized for CVD. Of 88 patients for whom hospital admission was advised, 72 (81.8%) were immediately referred within 48 hours following the tele-ECG consultation. Conclusions: Tele-ECG can be implemented in Indonesian primary care settings with limited resources and may assist the GPs for immediate triage, results in higher rate of early hospitalization for indicated patients.

Diabetes and Frailty: An Expert Consensus Statement on the Management of Older Adults with Type 2 Diabetes

“…Remote blood glucose monitoring linked to web-based cloud technologies allows for the transfer of continuous glucose monitoring (CGM) data directly to healthcare professionals (e.g. intermittent CGM) [73,74]. However, the suitability of these telemedicine activities for the individual should be carefully considered, as they may not be effective in all cases [71,75].…”

Tele-electrocardiography in South-East Asia Archipelago: From a Basic Need for Healthcare Services to a Research Implementation

“…The tele-ECG has been instrumental in reducing the un-need patients referral and has allowed better allocation of resources through early triage of patients with acute CVD, based on their symptoms and examinations. Our previous study showed that 100% of ECG recordings were transmitted successfully and qualified for analysis; and thus, we suggest that tele-ECG can be implemented in Indonesian primary care settings with limited resources [6]. In traditional manner, when tele-ECG program was not applied, the ECG solely interpreted by the GP in the primary care center; or even worse, the ECG are not available as a basis healthcare service in several primary centers.…”

“…In traditional manner, when tele-ECG program was not applied, the ECG solely interpreted by the GP in the primary care center; or even worse, the ECG are not available as a basis healthcare service in several primary centers. By implementing this tele-ECG program, the consultation to the expert cardiologists may assist the GPs for immediate triage, resulting in a higher rate of early hospitalization for indicated patients, and eventually could reduce the mortality rate of acute CVD in Indonesia [6]. The flowchart of utilization and final purpose of tele-ECG is shown in Figure 1.…”