Telecardiology Activities in Hospital and University Cardiology Facilities in Italy: Survey Study

Telemedicine enables the provision of health services at a distance using information and communication technologies and includes different types of services: telemonitoring, remote control, virtual visit or televisit, telereferral, teleassistance, medical teleconsultation, health professionals' teleconsultation, and telerehabilitation. Continuous monitoring, early care, and greater therapeutic adherence could be benefits of telemedicine in the management of cardiovascular diseases. There are not many studies in the literature investigating the use of telemedicine in cardiology in Italy.

The aim of this study is to illustrate the results of a survey on telemedicine services in cardiology conducted by the Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging of the Italian National Institute of Health.

The Telehealth Quality of Care Tool (TQoCT) from the World Health Organization (WHO) was used as the model. A survey was disseminated by the National Association of Doctors and Hospital Cardiologists (ANMCO) from June 2024 to October 2024 through a link provided to hospital and university cardiology operative units identified through the 8th Census of Cardiological Structures in Italy. The facilities were contacted by email or telephone. The survey was built using Microsoft Forms and composed of 52 questions divided into 6 sections. The analysis was carried out for the whole national territory and by geographical area.

Of the 443 hospitals contacted, the response rate was 56.7% (251/443). Overall, 78.9% (198/251) of facilities reported telemedicine initiatives providing telemonitoring (128/198, 64.6%), telereferrals (104/198, 52.5%), medical teleconsultations (93/198, 47%), televisits (82/198, 41.4%), health professionals' teleconsultations (64/198, 32.3%), and telerehabilitation (10/198, 5.1%). The most frequently followed cardiovascular conditions were heart failure, ischemic heart disease, and cardiac arrhythmias, especially atrial fibrillation. Of the facilities, 51% (101/198) used deliberations, procedures, protocols, or informed consent for their activities, and 46% (91/198) of the reported services were paid. Lack of dedicated staff, complexity in organizational terms, and lack of technological equipment in the structure were the principal obstacles for health professionals; lack of familiarity with technology was the principal obstacle for patients.

There are still organizational and clinical limitations to resolve to make telemedicine in cardiology an integral part of medical practice. The true challenge of telecardiology is likely the integration of available technology with precise, concrete, and simplified organizational models. As a tool, technology is fundamental only if it is accessible and adequate. However, it must be integrated with new paths built according to the needs of the territory, patients, and health personnel. Such a survey could provide help for the future design and use of telemedicine services in cardiology in Italy.