IJCS | Volume 32, Nº2, March/April 2019

159 Farah et al. Diagnostic telecardiology in chest pain Int J Cardiovasc Sci. 2019;32(2)158-162 Original Article which structures and organizes emergency care in the country. The UPA 24h are structures of intermediate complexity between the primary health care units and the chain of hospitals. In the state of Rio de Janeiro, the UPA 24h were implemented in 2007. According to the state’s demand profile, there was a need for cardiology support to general practitioners working at the UPA 24h units in the care of patients with chest pain. In 2009, the Cardiology Consultancy Nucleus (CCN) was set up for the purposes of providing specialized remote assistance in the medical care for patients with cardiac disorders at these units. The objective of this study is to evaluate the support of telecardiology in the diagnostic qualification of chest pain in twenty-two 24-hour Emergency Care Units (UPA 24h) in the state of Rio de Janeiro. Methods Study design This is an observational, retrospective and quantitative study. Study population A study carried out with 9,692 patients evaluated by telecardiology, including 5,816 (60%) whowere admitted with chest pain supposedly caused by a cardiac disorder, in twenty-two UPA 24h in the state of Rio de Janeiro. The information was extracted from the database of the Cardiology Consultancy Nucleus of the Health Department (SES) of the State of Rio de Janeiro, from January 1, 2012 to December 31, 2013. Statistical Analysis The categorical variables were tabulated and analyzed using the Excel software ® , using simple descriptive statistics: absolute numbers, mean and frequency. Collection and evaluation of data by the Cardiology Consultancy Nucleus The purpose of the CCN was to answer questions and provide specialized advice to the diagnosis and decision-making of cardiac cases admitted by the general practitioner in the UPA. The general practitioner could request, whenever necessary, specialized support, based on the guidelines of the Brazilian Cardiology Society, as it related to the UPA 24h scenario. Among all the information collected by the CCN about the patients admitted with chest pain, the following were important to support the differential diagnosis: sex, age, main complaint, time of onset of symptoms, comorbidities, electrocardiogram (ECG), laboratory tests and physical examination information. At the first synchronous contact between the general practitioner and the telecardiologist, the latter collected the information reported and the initial diagnosis suggested by the UPA physician. The ECG was sent by fax or e-mail and immediately analyzed by the specialist. Based on this clinical, electrocardiographic and laboratory information (when laboratory tests were immediately required), the telecardiologist presented his/her diagnosis to the general practitioner and advised on the immediate management of the case. Therefore, all the information available for the clinical reasoning at the time of the teleconsultingwas shared between the general practitioner and the telecardiologist. Patient follow-up was performed by the CCN team through active search (bymaking daily calls to the UPA), assisting in themanagement of the cases until an outcome was reached. Once the telecardiologist issued an opinion, the patients who needed hospitalization were registered by the UPA in the State System of Regulation (SER) and/ or in the city’s system of regulation (Sisreg) for hospital transfer purposes. All patients underwent double-blind peer evaluation by the CCN team of cardiologists with over 10 years of experience in cardiology. In none of the cases was there diagnostic disagreement among the specialists. Results The mean age found in the group of patients admitted with chest pain was 59.20 ± 11.33 years, with a predominance of the male gender (59.32%, n = 3,450). The average length of stay in the UPA 24h was three days. Themain comorbidities reportedwere systemic arterial hypertension (49.87%; n= 2,900), diabetesmellitus (10.09%; n = 587), smoking (14.79%; n = 860), previous coronary artery disease (7.60%; n = 442), dyslipidemia (8.82%; n= 513), dilated cardiomyopathy (3.73%; n= 217), previous stroke (2.13%; n = 124), family history of coronary artery disease (2.13%; n = 124) and obesity (0.84%; n = 49). Of the 5,816 patients admitted for chest pain supposedly due to cardiac disorders and evaluated by