The role of telecardiology in supporting the decision-making process of general practitioners during the management of patients with suspected cardiac events

Abstract

We studied the role of telecardiology in reducing unnecessary hospital admissions of patients with suspected life-threatening cardiac events (CEs), evaluated by general practitioners (GPs). Over one month, 456 consecutive patients (mean age 65 years, SD 19) complaining of typical (10%) or atypical (42%) chest pain, palpitations (19%), dyspnoea (19%) or syncope (10%) were enrolled. Before teleconsultation, the GPs recorded their own opinion (based on clinical evaluation only) about the presence of a CE. Following transmission of the electrocardiogram (ECG), this opinion was compared with that of the cardiologist. In total there was agreement between the GP and cardiologist about the presence of a CE in 316 of the patients (69%) and disagreement in 140 patients (31%). This represents a specificity and sensitivity of the GPs' diagnosis of 76% and 47%, respectively. For 84 of 134 patients judged as having a CE by the GP, telecardiology avoided hospitalization; on the other hand, telecardiology identified a CE in 56 of 322 patients judged as not having a CE by the GP. Telecardiology is a useful tool with which to reduce unnecessary hospitalizations in patients with suspected life-threatening CEs.

The Role of Standard 12-lead ECG in a Telecardiology Consultation Service

“…Molinari et al studied the role of telecardiology in reducing unnecessary hospital admissions of patients with suspected life-threatening cardiac events, evaluated by general practitioners. One hundred general practitioners in remote rural areas in Italy sent a trans-telephonic 12-lead ECG, mostly from the patients' home to a cardiologist on 24/7 duty (Telemedicine Institute, Genoa) (Molinari et al, 2002). The general practitioners used transportable ECG equipment.…”

Telemedicine for cardiovascular disease continuum: A position paper from the Italian Society of Cardiology Working Group on Telecardiology and Informatics

“…Telecardiology may reduce unnecessary hospital admissions of patients with suspected life-threatening cardiac events, evaluated by general practitioners. Over one month, 456 consecutive patients complaining of typical or atypical chest pain, palpitations, dyspnea or syncope were enrolled, assessed by electrocardiogram and teleconsultation: in total there was agreement between the general practitioners and cardiologist about the presence of a cardiac event in 69% of the patients [13]. For 63% of patients judged as having a cardiac event by the general practitioner, telecardiology avoided hospitalization; on the other hand, telecardiology identified a cardiac event in 17% of patients judged as not having a cardiac event by the general practitioner.…”

Custo-benefício do serviço de telecardiologia no Estado de Minas Gerais: projeto Minas Telecardio

“…While there have been several experiences of tele-electrocardiography in Brazil and in the world 5,6 , there are limited data about the feasibility and economic benefit of its implementation in the public health system as support to primary healthcare 5,7 . Molinari et al 14 described the experience with 106,942 patients in Italy, in which the ECG was performed to clarify the cardiovascular symptoms or in routine consultations, but they did not describe any eventual economic benefits. Scalvini et al 15 studied 892 consecutive patients treated by general practitioners also in Italy, observing that the evaluation by consultant cardiologists was capable of significantly reducing referrals to emergency services and new cardiac tests, with significant cost reduction.…”