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

Background Electronic consultation (e-consultation) has proven effective in optimising communication between primary care and cardiology, reducing waiting times and unnecessary face-to-face referrals. Integrating remote diagnostic tools may further enhance its resolving capacity. Objective To assess the impact of incorporating tele-echocardiography and event-based electrocardiographic monitoring (EEM) within an advanced e-consultation model between primary care and cardiology. Tele-echocardiography and event-based ECG monitoring are alternative tools activated according to clinical criteria, not cumulative interventions. Tele-echocardiography or EEM are requested alternatively based on predefined clinical indications. Methods This prospective observational study included 1,200 consecutive e-consultations conducted in the A Estrada health district (Galician Health Service). In 354 cases, the advanced pathway was activated, with cardiologists requesting tele-echocardiography (n = 300) or EEM (n = 54). Echocardiographic studies were performed by a certified family physician and subsequently interpreted by the cardiologist. Results Remote resolution increased from 38.0% in the conventional e-consultation model to 54.3% in the advanced model (P < .01), allowing 195 additional cases to be resolved without face-to-face visits. Only 6.7% of tele-echocardiographic studies were non-interpretable. Diagnostic agreement was high (κ = 0.85 for tele-echo vs standard echo; κ = 0.75 for primary care vs cardiologist interpretation), with no major adverse events during a mean follow-up of 19 months. Conclusions This study represents one of the first structured implementations of tele-echocardiography and event-based ECG monitoring within a cardiologist-supervised e-consultation model. It suggests a potentially scalable and sustainable innovation aligned with the digital transformation goals promoted by the European Society of Cardiology.