A Telecardiologia no apoio ao diagnóstico diferencial da dor torácica nas Unidades de Pronto Atendimento (UPA 24h) do Estado do Rio de Janeiro

Abstract

Restropective analysis of the database from the Cardiology Consultancy Nucleus of the Health Department in the State of Rio de Janeiro with the objective to evaluate the application of telecardiology as a diagnostic support for patients with chest pain who presented at twenty two Emergency Care Units (ECU) from January 1, 2012 to December 31, 2013. The analysis identified the percentage of cases when the initial diagnosis made by a general practitioner was subsequently amended when the patient was evaluated, using telecardiology techniques, by a specialised cardiology consultant. The reasons for the different diagnoses and the progress of the patients concerned were also evaluated. During the period in question, 9,692 patients were evalutated by the Cardiology Consultant. Of this total, 5,816 (60%) patients were admitted with supposedly cardiological chest pain. On comparing the initial diagnosis made by the general practitioner at the ECU with the subsequent diagnosis made by the specialised telecardiology consultant, 1,593 (27.39%) resulted in amended diagnoses. The divergences arose when evaluating the electrocardiogram made on admission and the values of the myocardial necrosis markers, and relating the results to the clinical state presented by the patients. The initial ECU diagnosis of the divergent group indicated 1,477 patients (92.72%) with acute myocardial infarction without ST-segment elevation, 74 (4.64%) with acute myocardial infarction with ST-segment elevation, 40 (2.52%) with acute pulmonary edema and 2 (0.12%) with tachyarrhythmia. After telecardiological consultation, the diagnoses indicated 385 patients (24.17%) with unstable angina, 289 patients (18.14%) with congestive heart failure, 212 patients (13.31%) with acute pulmonary edema, 174 patients (10.92%) with with acute myocardial infarction with ST-segment elevation, 152 patients (9,54%) with hypertensive emergency, 113 patients (7.09%) with acute chronic renal failure, 89 patients (5.59%) with acute myocardial infarction without ST-segment elevation, 89 patients (5.59%) with pneumonia, 39 patients (2.45%) with sepsis, 26 patients (1.63 %) with myopericarditis, 20 patients (1.26%) with tachyarrhythmia and 5 patients (0.31%) with 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. Therefore, of a total of 1,593 patients with chest pain and discordant diagnosis, 1,255 (78.78%) were avoided for transfers to tertiary hospital beds. This fact translates into avoiding unnecessary costs to the National Health System with the occupation of intensive care beds and the accomplishment of cardiological exams, sometimes of high complexity, without the proper indication