Validation of remote cardiopulmonary examination in patients with heart failure with a videophone-based system

Background: The aim of this study was to evaluate feasibility and accuracy of a videophone-based system for remote cardiopulmonary examination of patients with heart failure. Methods and Results: Fifty patients were examined by 2 cardiologists, 1 with a conventional stethoscope and 1 remotely with a videophone-based method, employing an electronic stethoscope and transmitting through an integrated services digital network line. During both sessions, the cardiologists filled out a 27-item questionnaire, which was then compared; concordance between standard and remote examination was evaluated. In 92% of patients, electronic and acoustic auscultation concurred. Only in 3 patients (4%) did teleauscultation not permit a correct interpretation of lung examination. In one patient, bilateral fine crepitant rales were not detected during teleauscultation. Conversely, in the second, patient bilateral fine crepitant rales were recognized during teleauscultation, which were not confirmed during real-life auscultation. In the third nonconcordant patient, moderate-degree wheezing was not detected during teleauscultation. Fine crepitant rales were present at the lungs lower fields in 12 and wheezing in 3 additional patients, and were always correctly identified during teleauscultation. Overall, sensitivity, specificity, positive, and negative predictive value of remote lung auscultation were 88%, 97%, 94%, and 94%, respectively. Conclusions: Remote cardiopulmonary examination appears as a feasible method for assessing patients with heart failure. Telestethoscopy can therefore be reliably used in the context of comprehensive telecare programs.