A telemedicine network for remote paediatric cardiology services in north-east Brazil

Area of Science:

• Cardiology
• Public Health
• Telemedicine

Background:

• Congenital heart disease (CHD) care presents significant challenges in low- and middle-income countries.
• The State of Paraíba, Brazil, previously lacked a structured program for pediatric heart disease, leading to diagnostic delays and adverse outcomes.

Purpose of the Study:

• To evaluate the impact of a newly established pediatric cardiology network on CHD detection and management in Paraíba, Brazil.
• To assess the effectiveness of internet-based remote supervision and telemedicine in improving access to specialized cardiac care for children.

Main Methods:

• A collaborative network was formed between the Government of Paraíba and Círculo do Coração, employing a central cardiology team for supervision.
• Protocols for screening heart defects were developed, with echocardiograms performed under direct online cardiologist supervision or via reviewed video recordings.
• Weekly surgical interventions were conducted by cardiovascular surgeons at a central pediatric hospital.

Main Results:

• From 2012-2014, 73,751 infants were screened, identifying 857 CHD abnormalities. CHD detection rates rose significantly from 4.09 to 11.62 per 1000 live births (P<0.001).
• Over 6000 consultations and echocardiograms were facilitated through internet-based remote supervision.
• The network led to reduced diagnosis times, fewer transfers, shorter hospital stays, and 330 successful surgeries with a 6.7% mortality rate.

Conclusions:

• Remote supervision of echocardiography by cardiologists enhances CHD detection by neonatologists.
• Telemedicine, including virtual outpatient clinics, improves clinical management and resource allocation efficiency.
• Internet technology combined with simple screening methods offers a scalable solution for improving pediatric cardiology services in resource-limited regions.