Role of a telemedicine network provided by local pharmacies in the prevention and early management of cardiovascular events

Abstract Background As traditional healthcare systems face increasing demand, telemedicine, leveraging telecommunications to deliver healthcare remotely, has emerged as a promising alternative to enhance accessibility and reduce costs. However, evidence supporting its effectiveness in real-world applications remains limited. Purpose The aim of our study was to assess the feasibility and effectiveness of a pharmacy-based telemonitoring network evaluating its potential role in chronic as well as in the acute setting, by enhancing the appropriateness of referrals to the emergency department (ED). Methods Our Department of Cardiology, in collaboration with our National Association of Pharmacists and the Italian National Institute of Health, has implemented a telematic network currently involving 7056 pharmacies throughout the country connected to a single telemedicine platform (Health Telematic Network - HTN). Pharmacies are equipped to perform 12-lead ECGs, ABPM, and Holter ECGs. Exams are performed either for routine check-ups or when a patient presents with cardiac symptoms. Demographic and clinical data are collected, and then transmitted through the platform for real-time cardiological evaluation: if any abnormalities are detected, pts are referred either for further diagnostic investigations or clinical evaluation, or, in cases of life-threatening conditions, to the ED. We analyzed all the ECGs performed from February 2022 to 2023 totalling 266602 procedures and then conducted a retrospective review of ED referrals due to chest pain to assess the appropriateness of ED referral. Results Out of 266602 ECGs analyzed 89% were performed for routine check-ups, 11% were prompted by specific cardiac symptoms. Common abnormalities identified included: AV blocks (1st degree: 5849 pts; 2nd degree: 78 pts, 3rd degree: 40 pts); bundle branch block (LBBB: 2768 pts; RBBB 1522 pts); bifascicular block (1072 pts); atrial fibrillation (AF) (3988 pts); severe QT prolongation ( 500 msec) (195 pts); ST segment depression (176 pts) and ST segment elevation (151 pts). Referral to the ED was required in 1987 cases. The most common reason for ED referral was AF, accounting for 49.6% of the total; chest pain was identified as the second most prevalent cause (29.6% of the total). The retrospective analysis of ED referrals due to chest pain indicated that 71.2% of the cases had been appropriate. Finally, cost-effectiveness analysis estimated potential savings of 2’219’661 € for the hospital, based on an average cost of 207 € for each chest pain diagnostic work-up in the ED. Conclusion Our findings highlight the potential role of pharmacy-based telemonitoring network both in chronic care (primary and secondary prevention) as well as in the acute setting, by enhancing the appropriateness of referrals to the emergency department (ED).