IJCS | Volume 32, Nº2, March/April 2019

DOI: 10.5935/2359-4802.20180099 158 ORIGINAL ARTICLE International Journal of Cardiovascular Sciences. 2019;32(2)158-162 Mailing Address: Simone Farah Rua Principado de Mônaco, 24 apto 202. Postal Code: 22281-070, Botafogo, RJ - Brazil. E-mail: sifarah.cardio@gmail.com , sifarah2000@yahoo.com.br Telecardiology on the Diagnostic Support of Chest Pain in Twenty-Two Emergency Care Units (UPA 24h) in The State of Rio de Janeiro Simone Farah, 1 B runo Rustum Andréa, 2 R ogério Casemiro da Silva, 3 A lexandra Monteiro 1 Universidade do Estado do Rio de Janeiro (UERJ), 1 RJ - Brazil Instituto Estadual de Cardiologia Aloysio de Castro (IECAC), 2 RJ - Brazil Secretaria Estadual de Saúde do Rio de Janeiro (SES), 3 RJ - Brazil Manuscript received on January 15, 2018, revised manuscript on July 31, 2018, accepted on August 07, 2018. 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 admittedwith 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. (Int J Cardiovasc Sci. 2019;32(2)158-162) Keywords: Telemedicine/methods; Chest Pain/diagnostic imaging; Emergency Medical Services; Electrocardiography/methods; Myocardial Infarction. Introduction Cardiovascular diseases are the leading cause of death in the world and were responsible for 32% of deaths on the planet by 2015.¹ In Brazil, as reported by theMortality Information System - SIM - ischemic heart disease is the leading cause of death, 2 generating very highmedical and socioeconomic expenditures to the public health system. 3 In the United States of America, cardiovascular diseases have generated direct and indirect costs of more than 200 billion dollars to the health systemwith estimates of about US$ 220 billion in expenditures by 2020. 4 It is estimated that about 5% of patients with chest pain and myocardial infarction are mistakenly discharged without a confirmed diagnosis in the emergency room. 5 Early diagnosis and treatment of ischemic heart diseases are critical for the reduction of morbidity and mortality, hospitalization time and optimization of costs in emergency care. 3 Proper management and follow-up of these patients has been a priority for the public health system. 6 The 24-hour Emergency Care Units (UPA 24h) emerged as part of Brazil’s Emergency Policy program,