Telecardiology bridges the gap in pediatric heart care: A systematic review

Background Geographic disparities limit access to pediatric cardiology care in rural and underserved communities, contributing to delayed diagnosis, increased transfers, higher costs, and preventable morbidity. Telecardiology has emerged as a scalable strategy to address subspecialty workforce shortages. This review evaluates the effectiveness of telecardiology versus standard in-person care in improving diagnostic timeliness, access to specialist care, and clinical outcomes; its diagnostic accuracy relative to in-person evaluation; and barriers to implementation, in pediatric populations with congenital or acquired heart disease in rural or underserved communities. Methods PubMed, Medline, Scopus, and Google Scholar were searched, identifying 1200 articles; 182 underwent full-text review. After exclusions, 74 studies were quality appraised using the Joanna Briggs Institute checklist, and 49 high-quality studies were included, evaluating synchronous tele echocardiography, asynchronous store and forward transmission, or remote physiologic monitoring in pediatric patients in rural or resource limited settings. Results Across the 49 included studies, tele echocardiography demonstrated diagnostic concordance ≥98% versus in person evaluation, and fetal telecardiology achieved 100% sensitivity and specificity for complex congenital heart disease in select programs. In the included studies, telecardiology reduced time to diagnosis (100 vs. 147 min, P < .001), interfacility transport by up to 58%, and emergency department utilization (0.4–0.0 visits per patient month in one interstage monitoring program, P = 0.0004). Hospital survival improved from 29.8% to 54.1% ( P = 0.002) in one ECMO program, and post Stage II palliation complications decreased from 34.1% to 18.4% ( P = 0.02). Cost analyses showed net savings across settings. Barriers included broadband limitations, reimbursement constraints, and regulatory challenges. Conclusions Telecardiology is a high-impact, evidence-based strategy that can improve diagnostic efficiency, reduce interfacility transfers, lower healthcare utilization, and expand access to pediatric cardiology care without compromising outcomes when implemented with adequate sonographer training and infrastructure investment; consistent with clinical experience, these requirements have limited adoption of store-and-forward fetal echocardiography at some centers. Addressing reimbursement and regulatory barriers is essential for equitable, sustainable implementation.