Cardiovascular emergencies in primary care: an observational retrospective study of a large-scale telecardiology service

ABSTRACT BACKGROUND: Electrocardiograms (ECGs) are an essential examination for identification and management of cardiovascular emergencies.The aim of this study was to report on the frequency and recognition of cardiovascular emergencies in primary care units. DESIGN AND SETTING: Observational retrospective study assessing consecutive patients whose digital ECGs were sent for analysis to the team of the Telehealth Network of Minas Gerais. METHODS: Data from patients diagnosed with cardiological emergencies in the primary care setting of 750 municipalities in Minas Gerais, Brazil, between March and September 2015, were collected via telephone contact with the healthcare practitioner who performed the ECG. After collection, the data were subjected to statistical analysis. RESULTS: Over the study period, 304 patients with cardiovascular emergencies were diagnosed within primary care. Only 73.4% of these were recognized by the local physicians. Overall, the most frequent ECG abnormalities were acute ischemic patterns (44.7%) and the frequency of such patterns was higher among the ECGs assigned as emergency priority (P = 0.03). It was possible to obtain complete information on 231 patients (75.9%). Among these, the mean age was 65 ± 14.4 years, 57.1% were men and the most prevalent comorbidity was hypertension (68.4%). In total, 77.9% were referred to a unit caring for cases of higher complexity and 11.7% of the patients died. CONCLUSION: In this study, cardiovascular emergencies were misdiagnosed in primary care settings, acute myocardial ischemia was the most frequent emergency and the mortality rate was high.

【研究背景】心电图（Electrocardiograms, ECGs）是识别与处置心血管急症的关键检查方式。本研究旨在探究基层医疗机构中心血管急症的发生频率与临床识别情况。
【研究设计与场景】本研究为回顾性观察性研究，纳入连续收治的、将数字化心电图提交至米纳斯吉拉斯州远程医疗网络团队进行分析的患者。
【研究方法】本研究收集了2015年3月至9月间，巴西米纳斯吉拉斯州750个市县的基层医疗机构中被诊断为心血管急症的患者数据，通过电话联系执行心电图检查的医护人员完成数据采集，随后对采集到的数据开展统计学分析。
【研究结果】本研究周期内，基层医疗机构共确诊304例心血管急症患者，其中仅73.4%被当地医师识别。总体而言，最常见的心电图异常为急性缺血性改变（占比44.7%），且该类异常在标注为急诊优先级的心电图中占比更高（P=0.03）。最终共获取231例患者的完整临床信息（占总病例数的75.9%），该群体平均年龄为65±14.4岁，男性占比57.1%，最常见的合并症为高血压（占比68.4%）。总计77.9%的患者被转诊至更高层级的复杂病例诊疗机构，另有11.7%的患者最终死亡。
【研究结论】本研究表明，基层医疗机构对心血管急症存在漏诊或误诊情况，急性心肌缺血为最常见的急症类型，且患者整体死亡率较高。