Combination of Tele-Cardiology Tools for Cardiovascular Risk Stratification in Primary Care: Data from the PROVAR+ Study.

Autor:	Fraga LL; Hospital das Clínicas da Universidade Federal de Minas Gerais - Serviço de Cardiologia e Cirurgia Carvdiovascular, Belo Horizonte, MG - Brasil., Nascimento BR; Hospital das Clínicas da Universidade Federal de Minas Gerais - Serviço de Cardiologia e Cirurgia Carvdiovascular, Belo Horizonte, MG - Brasil.; Hospital Madre Teresa - Serviço de Hemodinâmica, Belo Horizonte, MG - Brasil.; Universidade Federal de Minas Gerais - Departamento de Clínica Médica - Faculdade de Medicina, Belo Horizonte, MG - Brasil., Haiashi BC; Hospital das Clínicas da Universidade Federal de Minas Gerais - Centro de Telessaúde, Belo Horizonte, MG - Brasil., Ferreira AM; Hospital das Clínicas da Universidade Federal de Minas Gerais - Centro de Telessaúde, Belo Horizonte, MG - Brasil., Silva MHA; Hospital das Clínicas da Universidade Federal de Minas Gerais - Centro de Telessaúde, Belo Horizonte, MG - Brasil., Ribeiro IKDS; Universidade Federal de São João del Rei - Campus Centro-Oeste Dona Lindu - Campus Divinópolis, Divinópolis, MG - Brasil., Silva GA; Universidade Federal de São João del Rei - Campus Centro-Oeste Dona Lindu - Campus Divinópolis, Divinópolis, MG - Brasil., Vinhal WC; Universidade Federal de São João del Rei - Campus Centro-Oeste Dona Lindu - Campus Divinópolis, Divinópolis, MG - Brasil., Coimbra MM; Universidade Federal de São João del Rei - Campus Centro-Oeste Dona Lindu - Campus Divinópolis, Divinópolis, MG - Brasil., Silva CA; Hospital das Clínicas da Universidade Federal de Minas Gerais - Serviço de Cardiologia e Cirurgia Carvdiovascular, Belo Horizonte, MG - Brasil., Machado CRL; Universidade Federal de São João del Rei - Campus Centro-Oeste Dona Lindu - Campus Divinópolis, Divinópolis, MG - Brasil., Pires MC; Universidade Federal de Minas Gerais - Instituto de Ciências Exatas - Departamento de Estatística, Belo Horizonte, MG - Brasil., Diniz MG; Hospital das Clínicas da Universidade Federal de Minas Gerais - Centro de Telessaúde, Belo Horizonte, MG - Brasil., Santos LPA; Faculdade de Ciências Médicas de Minas Gerais - Faculdade de Medicina, Belo Horizonte, MG - Brasil., Amaral AM; Universidade Federal de Ouro Preto - Departamento de Medicina, Ouro Preto, MG - Brasil., Diamante LC; Hospital das Clínicas da Universidade Federal de Minas Gerais - Centro de Telessaúde, Belo Horizonte, MG - Brasil., Fava HL; Hospital das Clínicas da Universidade Federal de Minas Gerais - Centro de Telessaúde, Belo Horizonte, MG - Brasil., Sable C; Children's National Health System - Cardiology, Washington, District of Columbia - EUA., Nunes MCP; Universidade Federal de Minas Gerais - Departamento de Clínica Médica - Faculdade de Medicina, Belo Horizonte, MG - Brasil.; Hospital das Clínicas da Universidade Federal de Minas Gerais - Centro de Telessaúde, Belo Horizonte, MG - Brasil., Ribeiro ALP; Hospital das Clínicas da Universidade Federal de Minas Gerais - Centro de Telessaúde, Belo Horizonte, MG - Brasil., Cardoso CS; Universidade Federal de São João del Rei - Campus Centro-Oeste Dona Lindu - Campus Divinópolis, Divinópolis, MG - Brasil.
Jazyk:	Portuguese; English
Zdroj:	Arquivos brasileiros de cardiologia [Arq Bras Cardiol] 2024 Apr 05; Vol. 121 (2), pp. e20230653. Date of Electronic Publication: 2024 Apr 05 (Print Publication: 2024).
DOI:	10.36660/abc.20230653
Abstrakt:	Background: Tele-cardiology tools are valuable strategies to improve risk stratification. Objective: We aimed to evaluate the accuracy of tele-electrocardiography (ECG) to predict abnormalities in screening echocardiography (echo) in primary care (PC). Methods: In 17 months, 6 health providers at 16 PC units were trained on simplified handheld echo protocols. Tele-ECGs were recorded for final diagnosis by a cardiologist. Consented patients with major ECG abnormalities by the Minnesota code, and a 1:5 sample of normal individuals underwent clinical questionnaire and screening echo interpreted remotely. Major heart disease was defined as moderate/severe valve disease, ventricular dysfunction/hypertrophy, pericardial effusion, or wall-motion abnormalities. Association between major ECG and echo abnormalities was assessed by logistic regression as follows: 1) unadjusted model; 2) model 1 adjusted for age/sex; 3) model 2 plus risk factors (hypertension/diabetes); 4) model 3 plus history of cardiovascular disease (Chagas/rheumatic heart disease/ischemic heart disease/stroke/heart failure). P-values < 0.05 were considered significant. Results: A total 1,411 patients underwent echo; 1,149 (81%) had major ECG abnormalities. Median age was 67 (IQR 60 to 74) years, and 51.4% were male. Major ECG abnormalities were associated with a 2.4-fold chance of major heart disease on echo in bivariate analysis (OR = 2.42 [95% CI 1.76 to 3.39]), and remained significant after adjustments in models (p < 0.001) 2 (OR = 2.57 [95% CI 1.84 to 3.65]), model 3 (OR = 2.52 [95% CI 1.80 to3.58]), and model 4 (OR = 2.23 [95%CI 1.59 to 3.19]). Age, male sex, heart failure, and ischemic heart disease were also independent predictors of major heart disease on echo. Conclusions: Tele-ECG abnormalities increased the likelihood of major heart disease on screening echo, even after adjustments for demographic and clinical variables.
Databáze:	MEDLINE
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