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
背景：远程心脏病学（Telecardiology）可为胸痛的诊断与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科收治患者的胸痛鉴别诊断中的应用价值。
研究方法：本研究为观察性回顾性档案研究，纳入巴西里约热内卢州22个急诊科收治的5816例疑似心源性胸痛患者。研究数据取自心脏病咨询中心数据库，采用Excel®软件进行制表及简单描述性统计分析。
研究结果：本研究中共1593例（27.39%）患者出现诊断不符情况。其中，当地初始诊断为非ST段抬高型心肌梗死（non-STEMI）者1477例（92.72%），急性ST段抬高型心肌梗死（STEMI）74例（4.64%），急性肺水肿（APE）40例（2.52%），快速性心律失常2例（0.12%）。所有上述患者均被建议转诊至重症监护病房。经远程心脏病学干预后，最终诊断结果为：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%），急性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%），心肌心包炎26例（1.63%），快速性心律失常20例（1.26%），瓣膜性心脏病5例（0.31%）。干预后患者转归情况为：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：远程心脏病学可有效辅助胸痛的诊断与管理，优化公立医疗系统内的住院收治流程。