P4234A telemonitoring program for screening and primary and secondary prevention of cardiovascular disease

Abstract

Background: Cardiovascular diseases (CV) have a high prevalence and incidence and are associated with a high rate of mortality and hospitalization, resulting in a significant spending on care and poor quality of life. Purpose: The aim of our study was to evaluate the effectiveness of a remote monitoring through the use of electrocardiogram (ECG), ambulatory blood pressure monitoring (ABPM) and ECG Holter monitoring in primary prevention (screening checks in healthy subjects and in patients at risk of CV diseases such as patients with diabetes, hypertension or dyslipidemia), and in secondary prevention after CV events. Methods: Health Telematic Network (HTN), in collaboration with our Cardiology Department and Federfarma (National Association of Pharmacists), has installed in 3,272 pharmacies distributed throughout the country a telematic network connected to a single Telemedicine platform where cardiologists were available for a 24-hour tele-consulting. Pharmacies performed 12-lead ECG for pimary prevention in healthy subjects or those with CV risk factors, ABPM in case of discordant blood pressure value or to assess the response to antihypertensive therapy and Holter ECG in subjects with episodes of palpitation, syncope or pre-syncope or a history of paroxysmal atrial fibrillation or ventricular or supraventricular extrasystoles. Results: From the 1th Jan 2015 to 31th Dec 2017 a total of 79,898 women (mean age 52±12) and 68,458 men (mean age 49±11) have benefited of our telematic network. We analyzed 148,352 exams: 94,985 ECG; 29,567 ABPM and 23,800 ECG Holter. Among all the ECG, 7,348 (7.7%) showed electrocardiographic abnormalities not compatible with the patient's medical history. Among the total of ABPM performed, 7,214 (24.4%) revealed an abnormal 24-hour pressure trend, according to the classification of European Society of Hypertension: 51% systo-diastolic hypertension; 26% isolated systolic hypertension; 23% isolated diastolic hypertension. Among all the ECG Holter monitoring, 6,414 (26.9%) showed arrhythmias: atrial fibrillation (2,220 patients), supraventricular tachycardia (1,172 patients), ventricular arrhythmias (1,391 patients), advanced atrioventricular block (770 patients) and QT corrected prolungation (861 patients); in 1,177 cases (4.9%) these arrhythmias were life threatening. In case of detections of abnormalities, subjects were referred to their General Practitioner or Cardiologist for further evaluation or further diagnostic investigations; in cases of life threatening conditions, patients were referred to the closest Emergency Department (ED). Conclusion: Our data confirm the important role of a telematic network in primary and secondary prevention of CV diseases, by promoting early diagnosis and treatment of CV events and by improving the appropriateness of the access to the ED, then resulting in a likely positive impact on health care and health expenditure.