Telecardiology on the Diagnostic Support of Chest Pain in Twenty-Two Emergency Care Units (UPA 24h) in The State of Rio de Janeiro

Abstract Background: Telecardiology may be a useful support in diagnosis and management of chest pain. Objective: Evaluate the application of telecardiology to support the differential diagnosis of chest pain in patients admitted to Emergency Care Units. Method: Observational, retrospective and documental study of 5,816 patients admitted with supposedly cardiological chest pain in twenty two Emergency Care Units in the state of Rio de Janeiro. Data were tabulated and analyzed by Excel® software, using simple descriptive statistics, from the database of the Cardiology Consultancy Nucleus. Results: Diagnostic disagreement was found in 1,593 (27.39%) cases. Of these, 1,477 (92.72%) were diagnosed locally as non-ST-elevation myocardial infarction (non-STEMI), 74 (4.64%) as acute myocardial infarction with ST-segment elevation (STEMI), 40 (2.52%) as acute pulmonary edema (APE) and 2 (0.12%) as tachyarrhythmia. Intensive care referral was requested to 100% of these patients. After telecardiology, the diagnoses were: 385 (24.17%) unstable angina, 289 (18.14%) congestive heart failure, 212 (13.31%) APE, 174 (10.92%) STEMI, 152 (9.54%) hypertensive emergency, 113 (7.09%) acute chronic renal failure, 89 (5.59%) non-STEMI, 89 (5.59%) pneumonia, 39 (2.45%) sepsis, 26 (1.63 %) myopericarditis, 20 (1.26%) tachyarrhythmia and 5 (0.31%) orovalvar disease. The outcome after telecardiology was 1,178 discharges (73.94%), 338 (21.21%) referrals, 62 (3.90%) deaths and 15 (0.95%) unknown. Conclusion: Telecardiology was effective in chest pain diagnosis and management, optimizing hospital admission in the public health system.

【摘要】研究背景：远程心脏病学（Telecardiology）可为胸痛的诊断与临床管理提供有效辅助支持。研究目的：评估远程心脏病学在辅助急诊监护病房（Emergency Care Units）收治患者的胸痛鉴别诊断中的应用价值。研究方法：针对巴西里约热内卢州22个急诊监护病房中5816例疑似心源性胸痛收治患者，开展一项观察性、回顾性文献研究。研究数据取自心脏病学咨询核心数据库（Cardiology Consultancy Nucleus），采用Excel®软件进行制表，并通过简单描述性统计方法开展分析。研究结果：共1593例（27.39%）病例存在诊断不符情况。其中，1477例（92.72%）被本地诊断为非ST段抬高型心肌梗死（non-STEMI），74例（4.64%）为ST段抬高型急性心肌梗死（STEMI），40例（2.52%）为急性肺水肿（APE），2例（0.12%）为快速性心律失常。所有上述患者均被要求转诊至重症监护室。经远程心脏病学评估干预后，最终诊断分别为：不稳定型心绞痛385例（24.17%）、充血性心力衰竭289例（18.14%）、急性肺水肿212例（13.31%）、ST段抬高型心肌梗死174例（10.92%）、高血压急症152例（9.54%）、急慢性肾衰竭113例（7.09%）、非ST段抬高型心肌梗死89例（5.59%）、肺炎89例（5.59%）、脓毒症39例（2.45%）、肌心包炎26例（1.63%）、快速性心律失常20例（1.26%）以及瓣膜疾病（orovalvar disease）5例（0.31%）。远程心脏病学干预后的临床转归为：出院1178例（73.94%）、转诊338例（21.21%）、死亡62例（3.90%）、转归不明15例（0.95%）。研究结论：远程心脏病学在胸痛的诊断与管理中成效显著，可优化公立医疗系统的住院收治流程。