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Pre-partecipation ECG screening of large populations has a significant socioeconomic impact. Technological progress now allows for high-tech-low-cost ECG screening using validated smartphone-based devices capable of guiding to the correct performance of a 12‑lead ECG by layman with no medical background. We enrolled 728 (364, 52% males) individuals, aged 12–13 years who underwent ECG screening with a smartphone 12‑lead ECG during school hours by layman volunteers. Correct electrodes placement was provided by a validated image-processing algorithm by the smartphone camera in the App. ECG interpretation was via a telecardiology platform and alterations classified following current standards. A total of 741 ECGs were recorded, of which 13(2%) were technically not interpretable. Mean PR, QRS and QTc were: 145 ± 22, 85 ± 19 and 387 ± 57 msec. No QTc prolongation was observed. Mean QRS axis was 15°; 26 (4%) patients presented an iRBB. T-wave inversion from V1-V3 was present in 145 (21%) subjects. Twenty-one(3%) patients were referred to second level examination: deep Q-waves in inferior leads in 12(1.6%), ventricular ectopics in 5(0.7%), anterior T-waves inversions V1-V4 in 3(0.4%); extreme right axis deviation in 1(0.3%). Second line investigations did not provide any definitive diagnosis. Total project costs (material equipment and human cost) was 14.460€, 19.51€ per individual. The potential net saving with respect to current pre-participation screening cost was 19%. Layman 12‑lead Smartphone-ECG population screening proved feasible and effective, with a rate of non-interpretable ECG of <5%. Potential cost-saving in ECG screening and recording was 19%, providing an appealing opportunity when large campaigns should be addressed also in developing countries. • Pre-partecipation ECG screening of large populations has significant socioeconomic impact. Technological progress allows for high-tech-low-cost ECG screening using smartphone-based devices capable of guiding a user with no medical background to perform a12-lead ECG. • We enrolled 728 (364, 52% males) individuals, aged 12–13 years who underwent ECG screening with a smartphone 12-lead ECG during school hours by layman volunteers. • Twenty-one(3%) patients were referred to second level examination, reasons were: deep Q-waves in inferior leads in 12(1.6%), ventricular ectopics in 5(0.7%), anterior T-waves inversions V1-V4 in 3(0.4%); extreme right axis deviation in 1(0.3%). • Total project costs was 14.460€, 19.51€ per individual. The potential net saving with respect to current pre-participation screening cost in ECG recording and interpretation was 19%. [ABSTRACT FROM AUTHOR]

The remote follow-up of pacemakers and implantable cardiac defibrillators (ICDs) usually includes scheduled checks and alert transmissions. However, this results in a high volume of remote data reviews to be managed. We measured the relative contribution of scheduled and alert transmissions to the detection of relevant conditions, and the workload generated by their management. At our center, the frequency of remote scheduled transmissions is 4/year. Moreover, all system-integrity and clinical alerts are turned on for wireless notification. We calculated the number of transmissions received from January to December 2020, and identified transmissions that necessitated in-hospital access for further assessment and transmissions that required clinical discussion with the physician. For all alert transmissions, we identified whether the alert was clinically meaningful (i.e. center was not previously aware of the condition and no action had yet been taken to treat it). Of 8545 transmissions received from 1697 pacemakers and ICDs, 5766 (67%) were scheduled and 2779 (33%) were alert transmissions received from 764 patients (45%); 499 (9%) scheduled transmissions required clinical discussion with the physician, but only 2 of these necessitated in-hospital visits for further assessment. Of the alert transmissions, 664 (24%) required clinical discussion, and 75 (3%) necessitated in-hospital visits. The proportion of alerts judged clinically meaningful was 7%. Scheduled transmissions generate 67% of remote data reviews for pacemakers and ICDs, but their ability to detect clinically relevant events is very low. A strategy that relies exclusively on alert transmissions could ensure continuity of patient monitoring while reducing the workload at the center. • In a remote follow-up service, two-thirds of remote data reviews are generated by scheduled data transmissions. • Scheduled transmissions display far less ability to detect clinically relevant events than automatic alerts. • A strategy based on alert transmissions could ensure continuity of patient monitoring while reducing the workload. [ABSTRACT FROM AUTHOR]

Copyright of European Research in Telemedicine / La Recherche Européenne en Télémédecine is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Telemedicine uses telecommunication and information technologies and provides clinical health care for people who are at a distance. Telecardiology is a type of telemedicine that can send electrocardiogram (ECG) signals over a wireless network to remote healthcare professionals. The aim of this paper is to simulate the transmission of ECG signals over a communication system that uses digital video broadcasting –terrestrial (DVB-T) or digital video broadcasting –satellite version 2 (DVB-S2) technologies. Bit error rate (BER) performance of this system is analyzed over an additive Gaussian white noise (AWGN) channel and compared to theoretical results. Keeping in mind that wireless channel suffers from multipath propagation, multiple-input multiple-output (MIMO) antenna technology is additionally used along with DVB-T in a fading environment. It is shown that DVB-S2 technology offers performance improvements of up to 18 dB over DVB-T in an AWGN channel. It is also shown that using MIMO along with DVB-T mitigates the effects of multipath and improves the performance. This improvement is around 5 dB. Being a superior technology, however, does not necessarily mean DVB-S2 should be chosen over DVB-T in every circumstance. For example, in the case where less delay is important (i.e. in real-time transmission) DVB-T might still be the choice of transmission of ECG signals if performance degradation can be tolerated. [ABSTRACT FROM AUTHOR]

Résumé Contexte Le tableau clinique de certaines pathologies cardiovasculaires exige une prise en charge spécialisée. En Côte d’Ivoire cette prise en charge spécialisée n’était réalisable qu’au Sud du pays à l’institut de cardiologie d’Abidjan. Objectif Le but de ce travail était de démontrer l’efficacité d’un projet de télécardiologie dans la prise en charge des pathologies cardiovasculaires en Afrique noire. Matériels et méthodes Nous avons établi un réseau de télémédecine en dotant onze centres de santé de kit médico-net (KMN) leur permettant de réaliser des électrocardiogrammes (ECG) en cas de nécessité et de les transmettre via Internet pour analyse par un cardiologue du CHU de Bouaké (au centre de la Côte d’Ivoire) de septembre 2008 à février 2014. Résultats Dix centres ont effectué 689 télé-ECG qui ont été lus par le cardiologue du CHU de Bouaké. La ville de Korhogo (Nord de la Côte d’Ivoire) avec 328 télé-ECG (47,6 %) a réalisé le plus de télétransmissions d’ECG. L’hypertension artérielle avec 25 % a été le motif le plus fréquent de la demande de télé-ECG et l’anomalie ECG la plus retrouvée était l’hypertrophie ventriculaire gauche dans 36 % des cas. Quatre diagnostics de syndrome coronarien STEMI (0,7 %) ont été retrouvés et les troubles du rythme en général ont représenté 7,2 % des anomalies. Conclusion La téléexpertise pour l’interprétation des ECG en Côte d’Ivoire est une application de télémédecine simple, réalisable et efficace qui contribue au diagnostic et à la prise en charge de certaines pathologies cardiovasculaires. Summary Context The management of cardiovascular diseases demands accessibility to specialists. In the Ivory Coast, this specialized management of cardiovascular diseases is feasible only in the south of this country, at the Cardiology Institute in Abidjan. Objective The purpose of this study was to demonstrate the effectiveness of a telecardiology project in the management of cardiovascular diseases in black Africa. Materials and methods We established a telemedicine network by providing eleven health centers with “Medico-net” kits (MNK), allowing them to perform electrocardiograms (ECGs) when necessary and transmit them via the Internet for analysis by an expert cardiologist at the University Hospital of Bouaké (located at the center of the Ivory Coast) from September 2008 to February 2014. Results Of the eleven pre-selected centers, ten centers performed 689 tele-ECGs that were read by the cardiologist of the University Hospital of Bouaké. The city of Korhogo (in northern Ivory Coast), with 328 tele-ECGs (47.6%), was the most active site in the realization and the teletransmission of ECGs. The most frequent motive for requesting a tele-ECG was hypertension in 25% of cases; left ventricular hypertrophy was the most frequent anomaly found on ECG in 36% of cases. Four diagnoses of acute coronary syndrome STEMI (0.7%) were made and arrhythmia generally represented 7.2% of the anomalies found. Conclusion Using tele-expertise for the interpretation of ECGs in the Ivory Coast is a simple, practicable and effective application of telemedicine which contributes to the diagnosis and to the management of some cardiovascular diseases. [ABSTRACT FROM AUTHOR]

Telemedicine is the provision of health care services, through the use of information and communication technology, in situations where the health care professional and the patient, or 2 health care professionals, are not in the same location. It involves the secure transmission of medical data and information, through text, sound, images, or other forms needed for the prevention, diagnosis, treatment, and follow-up of a patient. First data on implementation of telemedicine for the diagnosis and treatment of acute myocardial infarction date from more than 10 years ago. Telemedicine has a potential broad application to the cardiovascular disease continuum and in many branches of cardiology, at least including heart failure, ischemic heart disease and arrhythmias. Telemedicine might have an important role as part of a strategy for the delivery of effective health care for patients with cardiovascular disease. In this document the Working Group on Telecardiology and Informatics of the Italian Society of Cardiology intends to remark some key-points regarding potential benefit achievable with the implementation of telemedicine support in the continuum of cardiovascular disease. [ABSTRACT FROM AUTHOR]

Cardiovascular disease (CVD) is one of the most widespread health problems with unpredictable and life-threatening consequences. The electrocardiogram (ECG) is commonly recorded for computer-aided CVD diagnosis, human emotion recognition and person authentication systems. For effective detection and diagnosis of cardiac diseases, the ECG signals are continuously recorded, processed, stored, and transmitted via wire/wireless communication networks. But long-term continuous cardiac monitoring system generates huge volume of ECG data daily. Therefore, a reliable and efficient ECG signal compression method is highly demanded to meet the real-time constraints including limited channel capacity, memory and battery-power of remote cardiac monitoring, ECG record management and telecardiology systems. In such scenarios, the main objective of the ECG signal compression is to reduce the data rate for effective transmission and/or storage purposes without significantly distorting the clinical features of different kinds of PQRST morphologies contained in the recorded ECG signal. Numerous ECG compression methods have been proposed by exploiting the intra-beat correlation, inter-beat correlation and intra-channel correlation of the ECG signals. This paper presents a prospective review of wavelet-based ECG compression methods and their performances based upon findings obtained from various experiments conducted using both clean and noisy ECG signals. This paper briefly describes different kinds of compression techniques used in the one-dimensional wavelet-based ECG compression methods. Then, the performance of each of the wavelet-based compression methods is tested and validated using the standard MIT-BIH arrhythmia databases and performance metrics. The pros and cons of different wavelet-based compression methods are demonstrated based upon the experimental results. Finally, various practical issues involved in the validation procedures, reconstructed signal quality assessment, and performance comparisons are highlighted by considering the future research studies based on the recent powerful digital signal processing techniques and computing platform. [ABSTRACT FROM AUTHOR]

Copyright of Archives of Cardiovascular Diseases is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of European Research in Telemedicine / La Recherche Européenne en Télémédecine is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

COVID-19 pandemic severely affected national health systems, altering the modality and the type of care of patients with acute and chronic diseases. To minimize the risk of exposure to SARS-CoV2 for patients and health professionals, face-to-face visits were cancelled or postponed and the use of telemedicine was strongly encouraged. This reorganization involved especially patients with rare diseases needing periodic comprehensive assessment, such as pulmonary arterial hypertension (PAH). The paper reports a proposal of strategy adopted for patients followed at our PAH center in Rome, where patients management was diversified based on clinical risk according to the European Society of Cardiology/European Respiratory Society PH guidelines-derived score and the REVEAL 2.0 score. A close monitoring and support of these patients were made possible by policy changes reducing barriers to telehealth access and promoting the use of telemedicine. Synchronous/asynchronous modalities and remote monitoring were used to collect and transfer medical data in order to guide physicians in therapeutic-decision making. Conversely, the use of implantable monitors providing hemodynamic information and echocardiography-mobile devices wirelessly connecting was limited by the poor experience existing in this setting. Large surveys and clinical trials are welcome to test the potential benefit of the optimal balance between traditional PAH management and telemedicine opportunities. Italy was found unprepared to manage the dramatic effects caused by COVID-19 on healthcare systems. In this emergency situation telemedicine represented a promising tool especially in rare diseases as PAH, but was limited by its scattered availability and legal and ethical issues. Cohesive partnership of health care providers with regional public health officials is needed to prioritize PAH patients for telemedicine by dedicated tools. [ABSTRACT FROM AUTHOR]

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Abstract: Purpose: Implementation of telemedicine in many clinical scenarios improves the quality of care and patient safety. However, its use is hindered by operational, infrastructural and financial limitations. This paper describes the design and deployment of a plug-and-play telemedicine platform for cardiologic applications. Methods: The novelty of this work is that, instead of complex middleware, it uses a common electronic mailbox and its protocols to support the core of the telemedicine information system and associated data (ECG and medical images). A security model was also developed to ensure data privacy and confidentiality. Results: The solution was validated in several real environments, in terms of performance, robustness, scalability and work efficiency. During the past three years it has been used on a daily basis by several small and medium-sized laboratories. Conclusions: The advantage of using an Internet service in opposition to a server-based infrastructure is that it does not require IT resources to set up the telemedicine centre. A doctor can configure and operate the centre with the same simplicity as any other Internet browser application. The solution is currently in use to support remote diagnosis and reports of ECG and Echocardiography in Portugal and Angola. [Copyright &y& Elsevier]

Copyright of European Research in Telemedicine / La Recherche Européenne en Télémédecine is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of IRBM is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: Today''s coronary care unit patients include those with complicated and uncomplicated myocardial infarction, decompensated heart failure and frank cardiogenic shock, severe valvular heart disease, high-grade conduction disturbances, and incessant ventricular arrhythmias. Increasingly in modern medicine, these conditions are not seen in isolation but rather in connection with a series of additional medical comorbidities. Increased life expectancy results in an increase in the prevalence of chronic cardiovascular diseases and an increased demand for health care services. Telemedicine is the provision of health care services, through the use of information and communication technology, in situations where the health care professional and the patient, or 2 health care professionals, are not in the same location. It involves the secure transmission of medical data and information, through text, sound, images, or other forms needed for the prevention, diagnosis, treatment, and follow-up of a patient. Telecardiology is one of the oldest applications in telemedicine and has been largely applied during the last 10 to 20 years. This study evaluated the feasibility of remote surveillance of coronary care unit and cardiology ward patient monitoring data by a “telecardiologist” with access to electronic health care record data and digitally stored 12-lead electrocardiograms. The remote access to the hospital intranet proved to be technically feasible. Also, the server applications used over the remote connection proved to be reliable and showed robustness against network performance variations. Extending remote patient surveillance to other hospitals is possible, provided that similar electrocardiogram and electronic health care record applications are available and a remote access can be arranged to them. However, the usability from cardiologist''s perspective may be degraded if connecting with multiple applications and hospital networks is needed. The study indicated potential for speeding up the diagnostic and therapeutic processes in the hospital, although the study was limited in that the telecardiologist played a passive role and did not acutely impact patient care. In the future, the system could be expanded to surveillance of smaller hospitals. Telemedicine has the potential to aid in solving the conflict between aging of population, rise in the demand for critical care services, and shortage of professional personnel. This might, however, require a more active remote surveillance than the one tested in this study. Privacy- and security-related aspects are major components of building trust and confidence in telemedicine systems. In telecardiology, the real-time interactive telemedicine model with 24/7 service has potential superior performance compared with a store-and-forward telemedicine model. [Copyright &y& Elsevier]

Abstract: Background: Chronic heart failure (CHF) remains a common cause of disability, death and hospital admission. Several investigations support the usefulness of programs of disease management for improving clinical outcomes. However, the effect of home-based telemanagement programs on the rate of hospital readmission is still unclear and the cost-effectiveness ratio of such programs is unknown. The aim of the study was to determine whether a home-based telemanagement (HBT) programme in CHF patients decreased hospital readmissions and hospital costs in comparison with the usual care (UC) follow-up programme over a one-year period. Methods and results: Four hundred-sixty CHF patients (pts), aged 57±10 years were randomised to two management strategies: 230 pts to HBT programme and 230 pts to UC programme. The HBT pts received a portable device, transferring, by telephone, a one-lead trace to a receiving station where a nurse was available for interactive teleconsultation. The UC pts were referred to their primary care physicians and cardiologists. The primary objective of the study was one-year hospital readmission for cardiovascular reasons. During one-year follow-up 55 pts (24%) in HBT group and 83 pts (36%) in UC group had at least one readmission (RR=0.56; 95% CI: 0.38–0.82; p =0.01). After adjusting for clinical and demographic characteristics, the HBT group had a significantly lower risk of readmission compared with the UC group (HR=0.50, 95% CI: 0.34–0.73; p =0.01). The intervention was associated with a 36% decrease in the total number of hospital readmissions (HBT group: 91 readmissions; UC group: 142 readmissions) and a 31% decrease in the total number of episodes of hemodynamic instability (101 in HBT group vs 147 in UC group). The rate of hearth failure-related readmission was 19% (43 pts) in HBT group and 32% (73 pts) in UC group (RR=0.49, 95% [CI]: 0.31–0.76; p =0.0001). No significant difference was found on cardiovascular mortality between groups. Mean cost for hospital readmission was significantly lower in HBT group (€ 843+/−1733) than in UC group (€ 1298+/−2322), (−35%, p <0.01). Conclusions: This study suggests that one-year HBT programme reduce hospital readmissions and costs in CHF patients. [Copyright &y& Elsevier]

Abstract: In this paper, two novel and simple, target distortion level (TDL) and target data rate (TDR), Wavelet threshold based ECG compression algorithms are proposed for real-time applications. The issues on the use of objective error measures, such as percentage root mean square difference (PRD) and root mean square error (RMSE) as a quality measures, in quality controlled/guranteed algorithm are investigated with different sets of experiments. For the proposed TDL and TDR algorithm, data rate variability and reconstructed signal quality is evaluated under different ECG signal test conditions. Experimental results show that the TDR algorithm achieves the required compression data rate to meet the demands of wire/wireless link while the TDL algorithm does not. The compression performance is assessed in terms of number of iterations required to achieve convergence and accuracy, reconstructed signal quality and coding delay. The reconstructed signal quality is evaluated by correct diagnosis (CD) test through visual inspection. Three sets of ECG data from three different databases, the MIT-BIH Arrhythmia (mita) ( Hz, 11b/sample), the Creighton University Ventricular Tachyarrhythmia (cuvt) ( Hz, 12b/sample) and the MIT-BIH Supraventricular Arrhythmia (mitsva) ( Hz, 10b/sample), are used for this work. For each set of ECG data, the compression ratio (CR) range is defined. The CD value of 100% is achieved for CR 12, CR 8 and CR 4 for data from mita, cuvt and mitsva databases, respectively. The experimental results demonstrate that the proposed TDR algorithm is suitable for real-time applications. [Copyright &y& Elsevier]

Background: Atrial fibrillation (AF) is the most common sustained cardiac tachyarrhythmia and is often an occasional diagnosis in the absence of known cardiac disease. The aim of this study is to describe an Italian patient population with AF followed by their General Practitioners (GPs) using a telecardiology service. Methods: A total of 655 Italian GPs were equipped with a portable electrocardiographer. The ECG tracing of all consecutive patients (7516) received between January and September 2001 was included into the study. Results: AF was detected in 719 patients (9.%) (77±12 years). In 448 patients, it was a known chronic condition, while in 271 patients, it was a new diagnosis. In the chronic AF, the principal reason for the teleconsultation was a routine control by the GPs, but an uncontrolled cardiac rate was present in 29% of the cases, while an antiplatelet or anticoagulation therapy was administered in only 46.2% cases. The teleconsultation alone provided a solution to the GPs'' requests in 348 patients (77.6%) (154 cases (34.5%) required no further action while 194 patients (43.5%) needed therapy adjustments only), while 47 patients (10.5%) required hospitalization and 51 patients needed further diagnostic tests. In 271 cases, a first evidence of atrial fibrillation was recorded: in 259 patients, GPs requested a teleconsultation in the presence of symptoms (mainly palpitation, dyspnoea and fatigue) and in 12 for routine control; in this case, 121 patients (46.9%) needed Emergency Department (ED) admission, 113 patients (39.1%) needed therapy adjustments and, for 19 patients (7.5%), further diagnostic tests were prescribed. Conclusion: In Italy, many patients, in particular the elderly, with AF are followed by their GPs on a routine basis; a telecardiology service may provide a useful tool in the home management of chronic AF and in the first detection of new cases of AF. [Copyright &y& Elsevier]

Introduction: The prevalence and mortality of cardiovascular diseases are high worldwide. Telecardiology can be used to diagnose and treat these diseases. This paper aimed to review the effectiveness (positive and negative) of implemented telecardiology services in terms of clinical, economic, and patient-reported aspects.Methods: A comprehensive search was conducted in Medline (through PubMed), Scopus, ISI web of science, and IEEE Xplore databases from inception to April 7, 2021. the studies that examined the effectiveness of telecardiology interventions were included.Results: Fifty studies were included in this systematic review. Most investigations (22%) were conducted in the US. In 22% of studies, telecardiology intervention was used for patients with heart failure. Telecardiology has been used in most studies for tele-monitoring (n = 21, 42%) and tele-consultation (n = 17, 34%) and in 29 studies (58%), was applied for ECG transmission. The highest rate of effects reported by studies was clinical. Thirty-five studies (70%) reported the clinical effects; twenty-one studies reported the positive effects for the economic category, and fifteen studies reported the positive effect for patient-reported class. The most positive clinical effects of telecardiology were early diagnosis, early treatment, and mortality reduction. The most positive effect of the economic class was the reduction of health care costs. The most effects of the patient-reported category were improving the patient's quality of life and patient satisfaction.Conclusion: Telecardiology can help early diagnosis and treatment of cardiovascular diseases. It also has great potential in reducing health care costs and increasing quality of life and patient satisfaction. [ABSTRACT FROM AUTHOR]

Copyright of European Research in Telemedicine / La Recherche Européenne en Télémédecine is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)