Remote telemedicine in urban settings: Prognostic value of chest pain

There is lack of studies on electrocardiogram (ECG) value performed where there is no specialized cardiological care. This study aims to investigate the value of chest pain and of the ECG alterations in patients that were taken care through a telemedicine project. A telecardiology system was implemented in 82 towns in Brazil with a population < 10.500 inhabitants. The patient is examined and the ECG is transmitted by internet to analysis at the universities. A cohort sub-study is conducted including patients with suspect or diagnosis of cardiovascular disease (CVD) measuring clinical evolution, quality of life (QOL), satisfaction with care and prognostic value of the alterations in the ECG. Descriptive and univariate analysis have been performed. In 18 months the project has carried out 32.626 ECGs. Preliminary results: 3.098 patients have been eligible for follow up; in 95% of them the ECG was done to investigate chest pain and 35% felt pain during the examination. In 50%, the intensity of the pain has varied from 5 to 10 (1-10). The initial ECG showed some alteration in 48,3%. The first follow up was performed in 2.388 patients, being 60% females, 50 years old average. Guidance to specialized care was carried out for 25% and, 10% have reported the confirmation of CVD. The QOL (WHOQOL) was 59,3 for physical domain as well as psychological and environmental, and 72,2 for social relations. Satisfaction with the medical care was 4,1, evaluated from CARDIOSATIS scale (1-5). A total of 35 patients died, with an average survival of 39 days after the first medical care and 85,0% of the relatives reported that the patient received adequate medical care. Pain at the moment of ECG was associated to confirmation of CVD and death (p<0,05). Preliminary results point out the effectiveness of the project on early diagnosis of CVD.