Tele-Electrocardiography and Mortality: Clinical Outcomes in Digital Electrocardiography Cohort–Data from Belo Horizonte, Brazil (CODE-BH)

Cardiovascular diseases are the leading cause of mortality in Brazil and around the world. The electrocardiogram (ECG) has a vital diagnostic and prognostic role in cardiovascular diseases. The CODE-BH cohort was established by linking ECG data (2006 to 2018) to hospitalization and mortality data from the public health database of Belo Horizonte, Minas Gerais, Brazil. It comprises 474,764 ECGs from 337,021 patients (mean age 54.42 years; 38.2% male), mostly from primary care centers. Clinical data were collected using a standardized questionnaire. ECG exams, hospitalization, and mortality information system data were linked using probabilistic linkage methods. The mortality rate was 3.4% (n = 11,518) with a mean follow-up of 3.3 years. Mortality was associated with older age, male sex, presence of any comorbidities, and major ECG abnormalities (p < 0.001). The presence of any ECG abnormality by Minnesota Code was associated with a higher risk of mortality (95% CI HR 1.45 (1.36–1.54) for minor abnormalities; HR 2.30 (2.16–2.44) for major abnormalities; p < 0.001), and cardiovascular hospitalization (95% CI HR 1.39 (1.28–1.50) for minor abnormalities; HR 3.12 (2.89–3.37) for major abnormalities; p < 0.001). This cohort brings novel data for epidemiological research. It encompasses a large amount of data from ECGs linked to clinical outcomes from a Latin American population.