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Covid19 has changed how we serve patients in all areas of health, and cardiology is no exception. Telemedicine is an option that hospitals can do during this pandemic. 

Telecardiology is part of telemedicine. By transmitting clinical data and electrocardiograms, telecardiology allows access to cardiology consultation services (telecardiology) without the need to travel to the practice area for both patients and cardiologists. These services can be in the form of teleconsultation, teleelectrocardiography, telerehabilitation, or teleechocardiography.

Telecardiology can be applied in prehospital (teleconsultation, teleelectrocardiography,) if there is a referral for a heart attack patient or consult for chronic heart disease through online media; at the hospital in the form of discussions with peripheral hospitals and referral hospitals (teleechocardiography with other small hospitals); and posthospital treatment can be performed for cardiac telerehabilitation in patients with heart failure or teleconsultation of posttreatment patients.


telemedicine telekardiologi layanan pre-RS layanan saat di RS layanan paska-RS

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How to Cite
Purwowiyoto, S. L., Achadi, A., & Wibowo, A. (2021). Telekardiologi dan Aplikasinya: Pendekatan Rumah Sakit selama Pandemi. Sanus Medical Journal, 2(1), 9–15.


  1. Nikus K, La¨hteenma¨ki J, Lehto P, et al. The role of continuous monitoring in a 24/7 telecardiology consultation service–a feasibility study. J Electrocardiol 2009; 42: 473–480.
  2. World Health Organization (WHO). A health telematics policy in support of WHO's Health-For-All strategy for global health development. Report of the WHO Group Consultation on Health Telematics, 11–16 December, Geneva, 1997. Geneva: WHO, 1998.
  3. Benschoter RA, Eaton MT and Smith P. Use of videotape to provide individual instruction in techniques of psychotherapy. J Med Educ 1965; 40: 1159–1161.
  4. Dwyer TF. Telepsychiatry: Psychiatric consultation by interactive television. Am J Psychiatry 1973; 130: 865–869.
  5. Sidhi Laksono and Budhi Setianto. Break the chain of COVID-19 transmission: Perspective from a cardiologist-in-practice. Indonesian J Cardiol. 2020; 41: 46-48.
  6. Zaman S, MacIsaac AI, Jennings GL, Schlaich M, Inglis SC, Arnold R, et al. Cardiovascular disease and COVID-19: Australian/New Zealand consensus statement. Med J Aust. 2020;1.
  7. Brahmbhatt DH, Cowie MR. Remote Management of Heart Failure: An Overview of Telemonitoring Technologies. Card Fail Rev. 2019;5(2):86-92.
  8. K. Nikus, J. Lähteenmäki, P. Lehto, M. Eskola, The role of continuous monitoring in a 24/7 telecardiology consultation service”a feasibility study. J. Electrocardiol. 2009; 42: 473–480.
  9. Federica Segato, Cristina Masella. Telemedicine services: How to make them last over time. Health Policy and Technology. 2017; 6(3): 268-278.
  10. Ahmed M. Soliman. Telemedicine in the Cardiovascular World: Ready for the Future? Methodist Debakey Cardiovasc J. 2020; 16(4): 283-90.
  11. World Health Organization. Monitoring and evaluating digital health interventions: a practical guide to conducting research and assessment. WHO: Geneva; 2016.
  12. S. Scalvini, F. Glisenti, Centenary of tele-electrocardiography and telephonocardiography ” where are we today? J. Telemed. Telecare. 2005; 11: 325–330.
  13. C.J. Terkelsen, B.L. Ní¸rgaard, J.F. Lassen, J.C. Gerdes, J.P. Ankersen, F. Rí¸mer, T.T. Nielsen, H.R. Andersen, Telemedicine used for remote prehospital diagnosing in patients suspected of acute myocardial infarction. J. Intern. Med. 2002; 252: 412–420.
  14. P. Giovas, D. Papadoyannis, D. Thomakos, G. Papazachos, M. Rallidis, D. Soulis, C. Stamatopoulos, S. Mavrogeni, N. Katsilambros, Transmission of electrocardiograms from a moving ambulance. J. Telemed. Telecare 1998; Suppl. 1(4): 5–7.
  15. B. Schwaab, A. Katalinic, J. Riedel, A. Sheikhzadeh, Pre-hospital diagnosis of myocardial ischaemia by telecardiology: safety and efficacy of a 12-lead electrocardiogram, recorded and transmitted by the patient. J. Telemed. Telecare 2005; 11: 41–44.
  16. C.J. Terkelsen, J.F. Lassen, B.L. Ní¸rgaard, J.C. Gerdes, S.H. Poulsen, K. Bendix, J.P. Ankersen, L.B. Gí¸tzsche, F.K. Rí¸mer, T.T. Nielsen, H.R. Andersen, Reduction of treatment delay in patients with ST-elevation myocardial infarction: impact of prehospital diagnosis and direct referral to primary percutaneous coronary intervention. Eur. Heart J. 2005; 26: 770–777.
  17. M. Sejersten, M. Sillesen, P.R. Hansen, S.L. Nielsen, H. Nielsen, S. Trautner, D. Hampton, G.S. Wagner, P. Clemmensen, Effect on treatment delay of prehospital teletransmission of 12-lead electrocardiogram to a cardiologist for immediate triage and direct referral of patients with ST-segment elevation acute myocardial infarction to primary percutaneous coronary intervention. Am. J. Cardiol. 2008; 101: 941–946.
  18. J.T. Sí¸rensen, C.J. Terkelsen, B.L. Ní¸rgaard, S. Trautner, T.M. Hansen, H.E. Bí¸tker, J.F. Lassen, H.R. Andersen, Urban and rural implementation of pre-hospital diagnosis and direct referral for primary percutaneous coronary intervention in patients with acute ST-elevation myocardial infarction. Eur. Heart J. 2011; 32: 430–436.
  19. N.D. Brunetti, G. Amodio, L. De Gennaro, G. Dellegrottaglie, P.L. Pellegrino, M. Di Biase, G. Antonelli, Telecardiology applied to a region-wide public emergency health-care service. J. Thromb. Thrombolysis. 2009; 28: 23–30.
  20. N.D. Brunetti, G. Di Pietro, A. Aquilino, A.I. Bruno, G. Dellegrottaglie, G. Di Giuseppe, C. Lopriore, L. De Gennaro, S. Lanzone, P. Caldarola, G. Antonelli, M. Di Biase, Prehospital electrocardiogram triage with telecardiology support is associated with shorter time to balloon and higher rates of timely reperfusion even in rural areas: data from the Bari-BAT public Emergency Medical Service 118 registry on primary angioplasty in STEMI. Eur. Heart J. Acute Cardiovasc. Care. 2014; 3: 204–213.
  21. N.D. Brunetti, L. De Gennaro, G. Amodio, G. Dellegrottaglie, P.L. Pellegrino, M. Di Biase, G. Antonelli, Telecardiology improves quality of diagnosis and reduces delay to treatment in elderly patients with acute myocardial infarction and atypical presentation. Eur. J. Cardiovasc. Prev. Rehabil. 2010; 17: 615–620.
  22. M. Sanchez-Ross, G. Oghlakian, J. Maher, B. Patel, V. Mazza, D. Hom, V. Dhruva, D. Langley, J. Palmaro, S. Ahmed, E. Kaluski, M. Klapholz, The STAT-MI (ST-Segment Analysis Using Wireless Technology in Acute Myocardial Infarction) trial improves outcomes. JACC Cardiovasc. Interv. 2011; 4: 222–227.
  23. A.W. Chan, J. Kornder, H. Elliott, R.I. Brown, J.F. Dorval, J. Charania, R. Zhang, L. Ding, A. Lalani, R.A. Kuritzky, G.J. Simkus, Improved survival associated with pre-hospital triage strategy in a large regional ST-segment elevation myocardial infarction program. JACC Cardiovasc Interv. 2012; 5: 1239–1246.
  24. C. de Waure, C. Cadeddu, M.R. Gualano, W. Ricciardi, Telemedicine for the reduction of myocardial infarction mortality: a systematic review and a meta-analysis of published studies. Telemed. J E Health. 2012; 18: 323–328.
  25. Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology (ESC), P.G. Steg, S.K. James, D. Atar, L.P. Badano, C. Blömstrom-Lundqvist, M.A. Borger, C. Di Mario, K. Dickstein, G. Ducrocq, F. Fernandez-Aviles, A.H. Gershlick, P. Giannuzzi, S. Halvorsen, K. Huber, P. Juni, A. Kastrati, J. Knuuti, M.J. Lenzen, K.W. Mahaffey, M. Valgimigli, A. van 't Hof, P. Widimsky, D. Zahger, ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur. Heart J. 2012; 33: 2569–2619.
  26. N.D. Brunetti, L. De Gennaro, G. Dellegrottaglie, D. Amoruso, G. Antonelli, M. Di Biase, A regional prehospital electrocardiogram network with a single telecardiology "hub” for public emergency medical service: technical requirements, logistics, manpower, and preliminary results. Telemed J E Health. 2011; 17: 727–733.
  27. A. Martinoni, S. De Servi, E. Boschetti, R. Zanini, T. Palmerini, A. Politi, G. Musumeci, G. Belli, M. De Paolis, F. Ettori, E. Piccaluga, D. Sangiorgi, A. Repetto, M. D'Urbano, B. Castiglioni, F. Fabbiocchi, M. Onofri, N. De Cesare, G. Sangiorgi, C. Lettieri, F. Poletti, S. Pirelli, S. Klugmann, Lombardima Study Group, Importance and limits of prehospital electrocardiogram in patients with ST elevation myocardial infarction undergoing percutaneous coronary angioplasty, Eur. J. Cardiovasc. Prev. Rehabil. 2011; 18: 526–532.
  28. K. Kalla, G. Christ, R. Karnik, R. Malzer, G. Norman, H. Prachar, W. Schreiber, G. Unger, H.D. Glogar, A. Kaff, A.N. Laggner, G. Maurer, J. Mlczoch, J. Slany, H.S. Weber, K. Huber, S.T.E.M.I. Vienna, Registry Group. Implementation of guidelines improves standard of care: the Viennese registry on reperfusion strategies in ST-elevation myocardial infarction (VIENNA-STEMI Registry). Circulation. 2006; 113: 2398–2405.
  29. J.G. Jollis, M.L. Roettig, A.O. Aluko, K.J. Anstrom, R.J. Applegate, J.D. Babb, P.B. Berger, D.J. Bohle, S.M. Fletcher, J.L. Garvey, W.R. Hathaway, J.W. Hoekstra, R.V. Kelly, W.T. Maddox Jr., J.R. Shiber, F.S. Valeri, B.A. Watling, B.H. Wilson, C.B. Granger, Reperfusion of Acute Myocardial Infarction in North Carolina Emergency Departments (RACE) Investigators. Implementation of a statewide system for coronary reperfusion for ST-segment elevation myocardial infarction. JAMA. 2007; 298: 2371–2380.
  30. R.A. Ducas, A.W. Wassef, D.S. Jassal, E. Weldon, C. Schmidt, R. Grierson, J.W. Tam, To transmit or not to transmit: how good are emergency medical personnel in detecting STEMI in patients with chest pain? Can. J. Cardiol. 28 (2012) 432–437. N.D. Brunetti et al. / International Journal of Cardiology. 2015; 184: 452–458 457
  31. E. Clark, M. Sejersten, P. Clemmensen, P.W. Macfarlane, Effectiveness of electrocardiogram interpretation programs in the ambulance setting, Comput. Cardiol. 2009; 36: 117–120.
  32. E.N. Clark, M. Sejersten, P. Clemmensen, P.W. Macfarlane, Automated electrocardiogram interpretation programs versus cardiologists' triage decision making based on teletransmitted data in patients with suspected acute coronary syndrome, Am. J. Cardiol. 2010; 106: 1696–1702.
  33. P. Kligfield, L.S. Gettes, J.J. Bailey, R. Childers, B.J. Deal, E.W. Hancock, G. van Herpen, J.A. Kors, P. Macfarlane, D.M. Mirvis, O. Pahlm, P. Rautaharju, G.S. Wagner, M. Josephson, J.W. Mason, P. Okin, B. Surawicz, H. Wellens, American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; American College of Cardiology Foundation; Heart Rhythm Society. Recommendations for the standardization and interpretation of the electrocardiogram: part I: the electrocardiogram and its technology a scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society endorsed by the International Society for Computerized Electrocardiology, J. Am. Coll. Cardiol. 2007; 49: 1109–1127.
  34. Evangelista A, Flachskampf F, Lancellotti P, et al. European Association of Echocardiography recommendations for standardization of performance, digital storage and reporting of echocardiographic studies. Eur J Echocardiogr 2008; 9: 438–448.
  35. Hsieh JC, Li AH and Yang CC. Mobile, cloud, and big data computing: Contributions, challenges, and new directions in telecardiology. Int J Environ Res Public Health 2013; 10: 6131–6153.
  36. Houston A, McLeod K, Richens T, et al. Assessment of the quality of neonatal echocardiographic images transmitted by ISDN telephone lines. Heart 1999; 82: 222–225.
  37. Grant B, Morgan GJ, McCrossan BA, et al. Remote diagnosis of congenital heart disease: The impact of telemedicine. Arch Dis Child 2010; 95: 276–280.
  38. Grant B, Morgan GJ, McCrossan BA, et al. Remote diagnosis of congenital heart disease: The impact of telemedicine. Arch Dis Child 2010; 95: 276–280.
  39. Huang T, Moon-Grady AJ, Traugott C, et al. The availability of telecardiology consultations and transfer patterns from a remote neonatal intensive care unit. J Telemed Telecare 2008; 14: 244–248.
  40. Sable CA, Cummings SD, Pearson GD, et al. Impact of telemedicine on the practice of pediatric cardiology in community hospitals. Pediatrics 2002; 109: E3.
  41. Randolph GR, Hagler DJ, Khandheria BK, et al. Remote telemedical interpretation of neonatal echocardiograms: Impact on clinical management in a primary care setting. J Am Coll Cardiol 1999; 34: 241–245.
  42. Trippi JA, Lee KS, Kopp G, et al. Dobutamine stress teleechocardiography for evaluation of emergency department patients with chest pain. J Am Coll Cardiol 1997; 30: 627–632.
  43. Scalvini S, Zanelli E, Comini L, et al. Home-based exercise rehabilitation with telemedicine following cardiac surgery. J Telemed Telecare 2009; 15: 297–301.
  44. Chiantera A, Scalvini S, Pulignano G, et al. Role of telecardiology in the assessment of angina in patients with recent acute coronary syndrome. J Telemed Telecare 2005; 11: S93–S94.
  45. Roth A, Malov N, Steinberg DM, et al. Telemedicine for post-myocardial infarction patients: An observational study. Telemed J E Health 2009; 15: 24–30.
  46. Dalleck LC, Schmidt LK and Lueker R. Cardiac rehabilitation outcomes in a conventional versus telemedicine-based programme. J Telemed Telecare 2011; 17: 217–221.
  47. Kashem A, Droogan MT, Santamore WP, et al. Managing heart failure care using an Internet-based telemedicine system. J Card Fail 2008; 14: 121–126.
  48. Riegel B, Carlson B, Glaser D, et al. Randomized controlled trial of telephone case management in Hispanics of Mexican origin with heart failure. J Card Fail 2006; 12: 211–219.
  49. Gambetta M, Dunn P, Nelson D, et al. Impact of the implementation of telemanagement on a disease management program in an elderly heart failure cohort. Prog Cardiovasc Nurs 2007; 22: 196–200.
  50. Hudson LR, Hamar GB, Orr P, et al. Remote physiological monitoring: Clinical, financial, and behavioral outcomes in a heart failure population. Dis Manage 2005; 8: 372–381.
  51. Klersy C, De Silvestri A, Gabutti G, et al. A meta-analysis of remote monitoring of heart failure patients. J Am Coll Cardiol 2009; 54: 1683–1694.