Telecardiology--close to the heart, but still out of reach.

legal consequences for both the patient and the consulting cardiologist. Enabling the consulting cardiologist to receive as many objective and imaging data as possible, in real time, is the perfect scenario. In this issue of IMAJ, Birati and Roth [3] review the latest data on the usefulness of telecardiology in various cardiac conditions. Although they focus on the Israeli experience and data, their article is most valuable for the questions and dilemmas it poses to the medical community and health systems worldwide. With the continuous reduction in post-myocardial infarction mortality and morbidity due to the routine use of primary percutaneous coronary intervention, statins, aspirin and clopidogrel [4], how many patients are truly at immediate high risk for severe life-threatening complications early postMI? And should a telecardiology service be offered to every patient post-MI or to only a select few? Improvement in survival can only be shown in a prospective randomized trial. But adequately sized randomized studies evaluating the role of telecardiology in post-MI patients are not yet available [5]. The most that can be said is that patients who subscribe to a telemonitoring service appear to have lower mortality than the general post-MI population, and this observation still requires prospective randomized validation in large-scale clinical trials. Although telecardiology is still in its infancy, the data suggest that patients with congestive heart failure derive the greatest benefit from the current technology [6]. In CHF patients, it reduces mortality and hospitalizations, often through improved patient compliance to medical care. This