# Advanced electronic consultation between primary care and cardiology: impact of tele-echocardiography and event-based electrocardiographic monitoring

## TL;DR

Adding tele-echocardiography and event-based ECG monitoring to e-consultations improved remote resolution and safety in cardiology care.

## Contribution

Demonstrates the feasibility and safety of integrating tele-echocardiography and EEM into e-consultation workflows.

## Key findings

- Remote resolution increased from 38.0% to 54.3% with the advanced e-consultation model.
- High diagnostic agreement was observed between tele-echo and standard echo (κ=0.85).
- No major adverse events occurred during a 19-month follow-up period.

## Abstract

Electronic consultation (econsultation) has proven effective in optimizing communication between primary care and cardiology, reducing waiting times and unnecessary face-to-face referrals. This study assessed the impact of incorporating tele-echocardiography and event-based electrocardiographic monitoring (EEM) into an advanced e-consultation model. A prospective observational cohort of 1200 consecutive e-consultations was analysed; in 354 cases, the advanced pathway was activated, including 300 tele-echocardiograms and 54 EEM studies. Remote resolution increased from 38.0% in the traditional model to 54.3% in the advanced model (P < 0.01). Diagnostic agreement was high (κ=0.85 for tele-echo vs. standard echo; κ =0.75 for primary care vs. cardiologist interpretation), with only 6.7% non-interpretable studies and no major adverse events during a mean follow-up of 19 months. This structured implementation of tele-echocardiography and EEM suggests a feasible, scalable, and safe innovation aligned with digital transformation goals in cardiology.