The Impact of Telematics on Cardiovascular Healthcare in Europe

1. The impact of telematics on cardiovascular healthcare in Europe:Experience with coronarography P. Menu, Fr.Marchessou, H. Young, Ph Boutaud ,M Grollet et J Ferrandis Poitiers and Wales University

2. Introduction • Distance learning in medicine is well established • The broadest definition of telemedicine is « medicine at a distance » • In Cardiology, telemedicine is developing around the imaging transfer. • For the coronarography, this transfer needs compression and the objective was to validate the compression method reliability.

3. Methods: Stage 1 • The coronarography patient records which are to be shared by coronarography sites and surgery units have two components • Half a dozen DICOM wavelets - compressed still images - are made anonymous at the console, and then fed through to a Web/Mail Server (DICOM SCP) for compression and distribution through Web access or clinical e-mails. • « video » images - DICOM multiframes - will be compressed with a ratio of 6 to 7 into an AVI sequence.

4. Methods: Stage 2 • Each case was given an anonymous bar code and the data was sent • The surgical team wrote their conclusions on an index card • The distance from Providence’ hospital and CHU is two kilometers.

6. Methods: Stage 3 • One surgeon went to the Providence hospital and looked at the real video tape recording A second card was established and the therapeutic options were compared

7. Clinical features Mr N, 55, no diabetes smoker, with a severe thoracic pain in January Pre-op investigations Normal ECG Training test positive at 45 Watts Transthoracic echo normal No Treatment

10. Material and methods N : 20 patients Age : 60.25+-16.4 (54/82) H/ F : 12 / 8 All the coronarography studies were done in Providence since November 1999 and March 2000 and the patients underwent surgery in CHU Poitiers 10 patients underwent surgery bypass 8 patients were traited by PTCA 2 patients received only medical therapy

11. Discrete concentric Readly accessible Nonangulated segment Smooth contour Non ostial in location Abscence of thrombus Tubular Eccentric Moderately angulated segment Ostial in location Modeate to heavy calcification Moderate tortuosity Lesion-specific CharacteristicsAmerican Heart Association/ American College of Cardiology classification of lesion type Type A Type B Type C Diffuse Total occlussion > 3 months Excessive tortuosity Inability protect major side branches Extremely angulated segment

12. Main left coronary > 75 % Multivessel coronary artery disease x 3 Left ventricular dysfunction Patient selection for surgery Unstable and resistant angina

13. Difference between the transfer interpretation and the real observation

14. RCA lesions and decisions

15. Distribution of lesions and type: 20 patients

16. LAD lesions and decisions

17. Results: Number of patients free from angina at baseline and at each the first 6 months

18. CFX lesions and decisions

20. Conclusion ( II ) • This study provides conclusive data on the evaluation of reliabilty after imaging transfer • Indeed, the interpretation of the compressed images was identical to the real time observation of the records

21. Summary

22. Conclusion (I) • It is a time of great changes in medicine. Not only is knowledge expanding but also patients’ expectations are on the increase. • New treatments and technologies require medical practitioners to continually update their own knowledge and skills to ensure that appropriateness of care is given Time and distance are no longer constraints. Telematics facilitates the managemnt of patients and the delivery of health care by bringing together distant and complementary teams.