Abstract
BackgroundTelemedicine has been a popular tool to overcome the lack of access to healthcare facilities, primarily in underprivileged populations. We aimed to describe and assess the implementation of a tele-electrocardiography (ECG) program in primary care settings in Indonesia, and subsequently examine the short- and mid-term outcomes of patients who have received tele-ECG consultations.MethodsECG recordings from thirty primary care centers were transmitted to Makassar Cardiac Center, Indonesia from January to July 2017. We cross-sectionally measured the performance of this tele-ECG program, and prospectively sent a detailed questionnaire to general practitioners (GPs) at the primary care centers. We performed follow-up at 30 days and at the end of the study period to assess the patient outcomes.ResultsOf 505 recordings, all (100%) ECGs were qualified for analysis, and about half showed normal findings. The mean age of participants was 53.3 ± 13.6 years, and 40.2% were male. Most (373, 73.9%) of these primary care patients exhibited manifested CVD symptom with at least one risk factor. Male patients had more ischemic ECGs compared to women (p < 0.01), while older age (> 55 years) was associated with ischemic or arrhythmic ECGs (p < 0.05). Factors significantly associated with a normal ECG were younger age, female gender, lower blood pressure and heart rate, and no history of previous cardiovascular disease (CVD) or medication. More patients with an abnormal ECG had a history of hypertension, known diabetes, and were current smokers (p < 0.05). Of all tele-consultations, GPs reported 95% of satisfaction rate, and 296 (58.6%) used tele-ECG for an expert opinion. Over the total follow-up (14 ± 6.6 months), seven (1.4%) patients died and 96 (19.0%) were hospitalized for CVD. Of 88 patients for whom hospital admission was advised, 72 (81.8%) were immediately referred within 48 h following the tele-ECG consultation.ConclusionsTele-ECG can be implemented in Indonesian primary care settings with limited resources and may assist GPs in immediate triage, resulting in a higher rate of early hospitalization for indicated patients.
Highlights
Telemedicine has been a popular tool to overcome the lack of access to healthcare facilities, primarily in underprivileged populations
From January to July 2017, a total of 505 ECG recordings were received in the analysis center of the telemedicine program, at Hasanuddin University Hospital
Patients with a normal ECG were significantly younger, mostly female, had lower systolic and diastolic blood pressure as well as a lower heart rate, and fewer had previously suffered from Cardiovascular disease (CVD) or taken cardiovascular medications, compared to those with abnormal ECG findings
Summary
Telemedicine has been a popular tool to overcome the lack of access to healthcare facilities, primarily in underprivileged populations. Telemedicine has become a popular tool in overcoming geographical barriers and increasing access to healthcare services. This benefits the rural and underserved populations in low- and middleincome countries – groups that traditionally suffer from lack of access to healthcare [1]. More than half of the Indonesian population lives in Java, with the rest distributed unevenly across ~ 6000 islands [2, 3]. Despite the high burden of CVD in this nation, in 2016 only 1.5 cardiologists per 1,000,000 population were available [4], and in 2013 there were ~ 30 cardiac centers (half located in Java) to serve > 2.6 million prevalent cases of CAD [5, 6]
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