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Usefulness of digital electrocardiograms in a new model of integration between primary health care and the centre for specialized attention cardiology section
M Facenda Lorenzo1, D Julio Hernandez Afonso1, DNA Raquel Pimienta Gonzalez1, D Celestino Hernandez Garcia1, D Luis Alvarez Acosta1, D? Ana Patricia Farina Ruiz1, D Diego Fernandez Rodriguez1, D Marcos Farrais Villalba1
1University Hospital Nuestra Se?? de Candelaria, Cardiology department, Santa Cruz de Tenerife, Spain
Topic: Telemedecine
Introduction: In digital electrocardiography, the signal is processed analogically and digitalized. The resulting electrocardiogram (ECG) can be stored and transmitted electronically (DICOM format) for specialist interpretation. Generally, analogic ECGs (on paper) have been used in primary care centres. There is little evidence of the usefulness of digital ECGs in clinical practice.
Purpose: We assessed the usefulness of digital ECGs and electronic transmission in a virtual consultation model integrating Primary Health Care (PHC) centres and the hospital-dependent Centre for Specialized Attention (CSA) cardiology section.
Methods: We performed a pilot project involving two PHC centres serving a population of 33,805 inhabitants and the CSA cardiology section. All PHC patients with symptoms suggestive of heart disorder or known heart conditions were considered eligible for virtual specialist assessment 5 days per week (maximum 10 patients per day) with a maximum response time of 48 hours. Clinical information, medical history and ECGs were used to decide whether the patient needed to visit the cardiologist or the case could be safely resolved with the information obtained. We evaluated clinical data, reasons for consultation (PHC physician doubts about ECG interpretation, symptoms or findings on physical examination and medication or therapeutic approach), and the decision taken by the cardiologist (on a specialist visit or not).
Results: From 19 February 2013 to 04 March 2014, 1,469 PHC patients were subject to virtual consultation: 48.9% men; 51.1% women, mean age 65.8 ±17.9 years. The main reason was abnormalities in routine ECG in 22% of cases followed by rhythm disturbances (palpitations, pre-syncope or syncope) in 15.7%. In addition, 12.3% of patients had atrial fibrillation, 11.5% chest pain, 7.4% chronic ischemic heart disease, 7.3% heart failure, 6.7% murmurs and 6.7% required treatment adjustment. Almost two thirds (61.3%) required appointments with the CSA cardiologist but 38.7% of cases were safely resolved without an appointment. These patients were closely monitored.
Conclusions: The main reason for virtual consultation was uncertainty about ECG interpretation. Digital ECGs interpreted by the CSA specialist allowed safe resolution in almost 40% of cases, which demonstrates their usefulness in clinical practice.
