Telemed J E Health - Hot spot: impact of July 2011 heat wave in southern Italy (Apulia) on cardiovascular disease assessed by emergency medical service and telemedicine support.

Tópicos

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Resumo

CKGROUND: Heat waves have been reported as being associated with increased rates of hospitalizations and deaths.MATERIALS AND METHODS: In July 2011, a heat wave hit southern Italy. We enrolled 9,282 consecutive patients who called the Apulia (southeastern Italy) regional free public emergency medical service (EMS) "118" number (out of 4 million inhabitants) during July 2011. All patients were evaluated with a prehospital electrocardiogram (ECG) thanks to telecardiology support provided by a single telemedicine hub. Local temperatures and relative humidity were recorded and combined in order to calculate the heat index (HI), a more accurate parameter to assess perceived discomfort caused by hot temperatures.RESULTS: The mean number of calls to the telecardiology hub for prehospital ECG screening in the case of suspected heart disease was increased 48 h after days with an HI = 44 (402 ? 68 versus 275 ? 52, p<0.001, +46%), when the number of calls was directly related to HI values (p < 0.01). ECG diagnoses of new-onset atrial fibrillation were significantly increased 24 h after days with an HI = 44 (12 ? 7 versus 8 ? 3, p<0.01, +50%). ECG diagnoses of ST-elevation acute myocardial infarction, in contrast, remained substantially unchanged. No significant gender or age (>70 versus <70 years) differences were observed (chi-squared p not significant); increased rates of EMS callings were found 48 h after days with an HI = 44 in hypertensive patients (131 ? 42 versus 78 ? 26, p<0.001, +68%) and subjects with prior cardiovascular disease (137 ? 43 versus 89 ? 22, p<0.001, +54%).CONCLUSIONS: Increased work burden for EMS assessed with prehospital telecardiology screening accompanies heat waves because of subjects calling for suspected acute heart disease. Prehospital screening with telecardiology support may be of help in identifying subjects who do not require hospitalization in the event of heat waves with increased calls to EMS.

Resumo Limpo

ckground heat wave report associ increas rate hospit deathsmateri method juli heat wave hit southern itali enrol consecut patient call apulia southeastern itali region free public emerg medic servic em number million inhabit juli patient evalu prehospit electrocardiogram ecg thank telecardiolog support provid singl telemedicin hub local temperatur relat humid record combin order calcul heat index hi accur paramet assess perceiv discomfort caus hot temperaturesresult mean number call telecardiolog hub prehospit ecg screen case suspect heart diseas increas h day hi versus p number call direct relat hi valu p ecg diagnos newonset atrial fibril signific increas h day hi versus p ecg diagnos stelev acut myocardi infarct contrast remain substanti unchang signific gender age versus year differ observ chisquar p signific increas rate em call found h day hi hypertens patient versus p subject prior cardiovascular diseas versus p conclus increas work burden em assess prehospit telecardiolog screen accompani heat wave subject call suspect acut heart diseas prehospit screen telecardiolog support may help identifi subject requir hospit event heat wave increas call em

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