Hot spot: impact of July 2011 heat wave in southern Italy (Apulia) on cardiovascular disease assessed by emergency medical service and telemedicine support.

BACKGROUND: Heat waves have been reported as being associated with increased rates of hospitalizations and deaths. MATERIALS AND METHODS: In July 2011, a heat wave hit southern Italy. We enrolled 9,282 consecutive patients who called the Apulia (southeastern Italy) regional free public emergency medical service (EMS) "118" number (out of 4 million inhabitants) during July 2011. All patients were evaluated with a prehospital electrocardiogram (ECG) thanks to telecardiology support provided by a single telemedicine hub. Local temperatures and relative humidity were recorded and combined in order to calculate the heat index (HI), a more accurate parameter to assess perceived discomfort caused by hot temperatures. RESULTS: The mean number of calls to the telecardiology hub for prehospital ECG screening in the case of suspected heart disease was increased 48 h after days with an HI ≥ 44 (402 ± 68 versus 275 ± 52, p<0.001, +46%), when the number of calls was directly related to HI values (p < 0.01). ECG diagnoses of new-onset atrial fibrillation were significantly increased 24 h after days with an HI ≥ 44 (12 ± 7 versus 8 ± 3, p<0.01, +50%). ECG diagnoses of ST-elevation acute myocardial infarction, in contrast, remained substantially unchanged. No significant gender or age (>70 versus <70 years) differences were observed (chi-squared p not significant); increased rates of EMS callings were found 48 h after days with an HI ≥ 44 in hypertensive patients (131 ± 42 versus 78 ± 26, p<0.001, +68%) and subjects with prior cardiovascular disease (137 ± 43 versus 89 ± 22, p<0.001, +54%). CONCLUSIONS: Increased work burden for EMS assessed with prehospital telecardiology screening accompanies heat waves because of subjects calling for suspected acute heart disease. Prehospital screening with telecardiology support may be of help in identifying subjects who do not require hospitalization in the event of heat waves with increased calls to EMS.

Prevalence of cardiac arrhythmias in pre-hospital tele-cardiology electrocardiograms of emergency medical service patients referred for syncope.

AIM: To evaluate the rate of prevalence of significant arrhythmias in emergency medical service (EMS) subjects referred for syncope and screened with pre-hospital tele-cardiology ECG. METHODS: 2648 consecutive EMS patients referred for syncope were evaluated with tele-cardiology support. Pre-hospital ECGs were sent to a single tele-cardiology "hub", active 24/7 and serving a region of 4-million inhabitants, and promptly read by a cardiologist. Prevalence of any arrhythmias or conduction disturbances was recorded. RESULTS: In more than 55% of cases ECG findings were normal; in 13% ECG showed sinus tachycardia, in 9% sinus bradycardia. Prevalence of ventricular tachycardia was 0.20%, while significant AV-disturbances were present in 1.12% of cases (0.11% second-degree type 2 AV-block, 0.11% advanced AV-block, 0.19% third-degree AV-block, 0.45% junctional rhythm, 0.26% ventricular rhythm). Limited gender differences were detectable. No significant arrhythmias were found in subjects younger than 30 years. Prevalence of several arrhythmias was age related. CONCLUSIONS: Prevalence of significant arrhythmias among EMS patients referred for syncope and evaluated with pre-hospital tele-cardiology ECG is low, and almost absent in subjects below 30 years. Tele-cardiology pre-hospital screening by a single regional "hub" may be helpful for the prompt diagnosis of arrhythmia related syncope.

A regional prehospital electrocardiogram network with a single telecardiology "hub" for public emergency medical service: technical requirements, logistics, manpower, and preliminary results.

BACKGROUND: In patients with a major cardiac event, the first priority is to minimize time-to-treatment. For many patients, the first and fastest contact with the health system is through emergency medical services (EMS). However, delay to treatment is still significant in developed countries, and international guidelines therefore recommend that EMS use prehospital electrocardiogram (ECG). Many communities are implementing prehospital ECG programs, with different technical solutions. METHODS: We report on a region-wide prehospital ECG telecardiology program that involved 233,657 patients from all over Apulia (4 million inhabitants), Italy, who called the public regional free EMS telephone number "118." Prehospital ECG was transmitted by mobile phone to a single regional telecardiology "hub" where a cardiologist available 24/7 promptly reported the ECG, having a briefing with on-scene EMS personnel and EMS district central; patients were then directed to fibrinolysis or primary percutaneous coronary intervention (PCI) as appropriate. RESULTS: Patients were >70 years in 51% of cases, and 55% of prehospital ECGs were unremarkable; the remaining 45% showed signs suggesting acute coronary syndrome (ACS) in 18%, arrhythmias in 20%, and minor findings in 62%. In cases of suspected ACS (chest pain), ECG findings were normal in 77% of patients; 74% of subjects with suspected ACS were screened within 30' from the onset of symptoms. CONCLUSIONS: A regional single telecardiology hub providing prehospital ECG for a sole regional public EMS provides an example of a prehospital ECG network optimizing quality of ECG report and uniformity of EMS assistance in a large region-wide network.