Cardiovascular Research Unit, Edgware General Hospital London, UK
To assess the initial phase of a telecardiology diagnostic service for general practitioners(CPs), we provided 93 CPs in 26 health centres with direct telephone access to a cardiologist, and equipped them with hand-held, automatic standard 12-lead electrocardiogram (ECC) transmitters for on-line cardiac consultations and ECC interpretation in their daily practice. Clinical details, reason for consultation and the ECC signal were transmitted from the CPs' practices or the patients' homes.
A consultation followed and a full report, including ECC print-out, was then sent to the CP. During an 18-month study period, 2563 consultations were carried out. The system allowed the identification of 479 patients( 19%) with urgent cardiac problems and the remaining 2084 (81%) in whom admission or out patient investigation was unnecessary. Following the study, we distributed a questionnaire asking the CPs to rate the quality, define the use and consider the benefit of the service to their daily practice. We conclude that a telecardiology diagnosis and ECC interpretation service is simple, reliable and efficacious in routine primary care. lt offers instant access to cardiac assessment and supports the decision-making process of CPs. A preliminary cost comparison with a conventional referral indicated that a teleconsultation as substantially cheaper. We expect that the future incorporation of teleechocardiography would expand the scope of telecardiology even further and allow comprehensive cardiology consultation.