Cardiological Telemedicine moved the first paces in Italy in 1976 transmitting ECG from patients' homes to the hospital structures employ the common phone lines. 
It dates back to the eighties the most important Cardiological Telemedicine experience, established on initiative of the SIP and allowing the setting-up of two systems for the remote transmission of the ECG tracing: the “Cardio-phone “ and the “CardioBip” (2 shunts portable system). 
Over last years it has been introduced a system able to transmit, using the common phone line,  ECG tracing by a simple acoustic coupling to a phone (9,10). 

The  Cardiological Telemedicine experience at the Genoa Centre  

The Cardiological Telemedicine service, established at Genoa in April 1995, is a centralised operative structure, working twenty-four hours a day, and able to manage in real time and remote mode, a cardiac event in act. Many peripheral operative units are connected with the function to detect and transmit telematic way, besides the clinic-anamnestic data, also the patient's ECG by the means of 9 or 12 shunts pocket transtelephonic electrocardiograph. 
The Listening Station informative system employs the Operating System Novell 3.12 that allows the link to local stations and a server to store archives and electrocardiograph tracing. 
Cardiologists work twenty-four hours a day and supply in real time and remote mode reporting services and electrocardiograph diagnosis and general cardiological consultation. 
Over four years of activity the Centre has examined 28.117 patients (13.377 women), average age 61 years old. The most frequent symptomatologies complained have been Chest Pain/ Precordalgia (46%), Cardiopalmus (17%), Dyspnea (14%), Epigastralgia (5%), Lipothymia/Syncope (5%). In the 60% patients the ECG resulted normal, in the 38% electrocardiographic alterations have been detected and, even if clinically remarkable, have it has been applied, in the most serious cases too, home treatments of the cardiovascular affections. 
In the 2% of the cases the electrocardiographic alteration detected were cardiological urgencies and emergencies so it was immediately arranged the hospital admittance of the patient. 
The reported data highlight the possibility, by the means of a Cardiological Telemedicine service, to rationalise the health intervention by aiming on a side to a greater timeliness in intervening on patients showing cardiac events in act and on the other side to contain the health expenditure by reducing unfit hospital admittance. 
Of no less importance is also the reappraisal of the professional figure of the Physician of General Medicine that could be able to intervene on a cardiopath patient under the steady supervision of the Cardiologist. 
Within the cardiological urgencies/emergencies and especially in managing acute myocardial infarction (IMA) patients, the Cardiological Telemedicine must play a basic role in reducing the extra-hospital mortality and the magnitude of the myocardial damage in the IMA. 
The extra-hospital mortality due to IMA still keeps high and it is likely related to the high precoronary times the patient with IMA in act is submitted. 
Between the pre-coronary times, the decisional time (DT), that is the time passed between the onsets and the clinic-electrocardiographic diagnosis, is the variable that certainly influences the most the extra-hospital mortality. 
Over these 4 years of activity the Cardiological Telemedicine Centre gave IMA in act diagnosis (Ill.1) to 190 patients. 
The DT has been 0-1 hour in 70 patients (36.8%), 1-3 hours in 44 patients (23.2%), more than 3 hours in 76 patients (40%). 
Furthermore if we consider the organisation and within hospital average time, reported by literature on the Italian situation, it results that for the 60% of our patients the precoronary time has been less than 4 hours and that nearly the 30% of patients has reached the Coronary Unit within the first our of the IMA. 
So, even if the examined sample size was small and notwithstanding the data come from a run-over evaluation, we can reasonably assert that the Cardiological Telemedicine may contribute remarkably to reduce precoronary times and on consequence the extra-hospital mortality in patients affect by IMA in act. 

Conclusions 

Applying telematic system to cardiology opens new prospects in the management of patients with suspected cardiac event in act, both in diagnostic aspects and early treatment, and the health expenditure containment aspect (stay in hospital costs, lost working days). 
Finally, the Cardiological Telemedicine  may be deemed as a special innovative technological branch allowing monitoring and managing cardiopath patients thanks too a quick access to the experts' consultation without moving the patient. 
 

Giuseppe Molinari 
Cattedra di Cardiologia 
Università degli Studi - Genova. 
Centro Nazionale 
di Telemedicina Cardiologica - Genova