Telecardiology in a post-Covid19 world


According to the World Health Organization (WHO), cardiovascular diseases (CVD) are the number one killer in the world. They account for thirty-two percent of the death.

With radiology and psychiatry, cardiology is undoubtedly one of the medical specialties that can get the most out of telehealth. Patients living in rural areas will not have to travel for hours to go to a specialized center to attend a routine exam or rehabilitation session.

Remote electrocardiogram diagnostics increase the patients’ outcomes and improves the primary care center’s organization.

Most cardiovascular diseases also rely on a strong behavioral component that can be addressed remotely. Telehealth and Telecardiology can have powerful benefits for the patients, the healthcare systems, and society.

What is telecardiology?

In 1970, Herman Hurley reported the first use of electrocardiographic telemetry directly from an ambulance using a telephone line. Even though the signal was reported as excellent, transmitting a diagnostic-quality electrocardiogram has long been challenging.

The equipment and technologies are now readily available. From anywhere, paramedics or remote medical practices can send 12-lead ECG electrocardiograms over the internet or 5G network to specialize cardiology centers. In cardiology, a real-time diagnostic is key to save lives.

Interpreting an electrocardiogram may also be challenging for general practitioners. Nearly twenty years ago, Molinary et al. published a study on the early benefits of telecardiology for diagnosing acute coronary events. When comparing general practitioners’ opinions with cardiologists, thirty-one percent of the patients consulting for acute Cardiac Events were misdiagnosed.

Rural clinics tend to have a disproportionate number of elderly and chronic conditions patients. By accessing a cardiologist sooner or just for a second opinion, telecardiology services can be a lifesaver.

A survey conducted in 2017 showed that the average wait time to consult a cardiologist in a major metropolitan area was 21 days. In Covid-19 times, relying on Telemedicine is not good to have anymore but a critical component for any modern health system.

Present and future of telecardiology

Telehealth in cardiology is not limited to the analysis of an emergency electrocardiogram. By holistically considering patients, telecardiology can improve diagnostics, save lives, and improve life quality.

Pre hospital electrocardiogram analysis

For patients suffering from myocardial infarctions, reperfusion therapy is the recommended standard of care to reduce mortality and morbidity.

Teletriage is key. The ECG is recorded in the ambulance or primary care center and sent wirelessly to the intervention center. Once the on-call cardiologist has established the diagnostic, the catheterization laboratory can prepare for the patient’s arrival.

Sejersten et al. shown that the time from door to Percutaneous Coronary Intervention (PCI) was reduced by three folds when using teletriage and on-site remote diagnostics.

Remote Heart Monitoring

Remote Heart Monitoring (RHM) is also key for patients suffering from heart disease. Pacemakers are essentially computers with the ability to transmit data about the device’s and heart’s status.

The ability to review the information in real-time proved to reduce by 66% the number of hospitalization for atrial arrhythmia and by 50% the relative risk of death. Not only are the patients safer, but the costs are also dramatically reduced.

Adherence to lifestyle changes and the medication is key for cardiac patients to benefit from long term health. One of the drawbacks of RHM may be linked to the reduction in the number of in-person visits to the cardiologist. We believe that using Telemedicine has the potential to create a more intimate relationship between patients and caregivers.

Follow-Up and Rehabilitation

Heart failure still leads to high morbidity and a high 30-day readmission rate. The use of telehealthcare is a way to maintain follow-up visits easily. By empowering the patients to check their weight, blood pressure, and other vitals, they are more prone to adhere to the therapy and reduce adverse events.

The Centers for Medicare and Medicaid Services (CMS) recently added cardiac rehabilitation and intensive cardiac rehab to the list of approved telehealth services. This addition is somehow considered temporary.

Numerous telehealth services were approved to limit exposure to COVID-19. We suspect that once both the physicians and the patients and the healthcare system and private insurers have analyzed the many benefits, it may be hard to go backward.

In summary

Telecardiology has been proven a life-saving technology for a long time. The COVID-19 outbreak acted as a catalyst for the technologies and care providers to start implementing a coherent global approach.

Will it be for emergency care, rehabilitation, or just for reassuring a patient at home, the use of telehealth is dramatically increasing. Necessity is always the most efficient way to change habits.

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