The onset of paroxysmal atrial fibrillation does not occur randomly. The large patient population in the present study suggests that the circadian rhythm of paroxysmal atrial fibrillation is similar to that described for other cardiovascular diseases, with clustering of events in the morning and (to a lesser degree) late in the evening. Weekly and yearly circadian patterns are also prominent.

No abstract

No abstract

SummaryBackground: The rising cost of services provided by hospital emergency departments is of major concern. Attempts to reduce the costs of emergency cardiac care have thus far focused primarily on medical and administrative management in the hospital. The role of the patient in appropriate prehospital decision-making has been generally ignored.Hypothesis: Membership in "Shahal" (an integrative telemedicine system) may have beneficial effects on patient decision-making and national health costs.Methods: During a 6-month period, a random group of subscribers who had called for medical assistance during the previous 24 h were asked what action they would have taken had they not been Shahal subscribers. All study patients were followed for at least 7 days.Results: In all, 1,608 subscribers (age 7 1 k 13 years) were included. Of these, 5 14 replied that they "would have waited," 363 "would have contacted their physicians," and 73 1 "would have sought emergency department care." Of the presenting medical problems, 86% were resolved without utilizing hospital facilities. A mobile intensive care unit was dispatched in 412 (26%) cases. A cost estimate of abuse indicated that the service resulted in a savings to the national economy of approximately $830,000 per 10,000 members per year.Conclusions: This study demonstrated that Shahal membership can reduce costs of medical care and the number of hospital emergency department visits.

During the year of use in telehealth service for congestive heart failure parameters of hospitalization were improved, together with parameters of quality of life.