Hot Spot: impact of July 2011 heat-wave in southern Italy (Apulia) on cardiovascular disease assessed by Emergency Medical Service and tele-medicine support

Background: Heat waves have been reported as associated with increased rates of hospitalizations and deaths. Modern technologies currently available for at-home assessment of patients calling Emergency Medical Service (EMS) may however be helpful in managing increased work burden caused by heat waves. Methods: In July 2011 a heat wave hit Southern Italy. We enrolled 9,282 consecutive patients who called Apulia regional free public EMS "118" (4-million inhabitants, South-Eastern Italy) during the entire month of July 2011. All patients were evaluated with pre-hospital ECG thanks to tele-cardiology support provided by a unique tele-medicine hub. Local temperatures and relative humidity were recorded and combined in order to calculate Heat Index (HI), a more accurate parameter to assess perceived discomfort caused by hot temperatures. HI month-through values were compared with rates of EMS calls and ECG performed in case of suspected acute heart disease. Results: Increased "118" callings were observed just after peaks in HI index (407 on July 11 vs 219 on July 1, +87%, p 70 vs <70 years) differences were observed. Conclusions: Increased work burden for EMS accompanies heat waves because of subjects calling for suspected acute heart disease. Tele-cardiology support may be useful in identifying subjects needing urgent hospitalization or not needing immediate cardiologist consultation.