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Risk Stratification of Fetal Cardiac Anomalies in an Underserved Population Using Telecardiology
Bettina F Cuneo1, Christina A Olson, Caitlin Haxel
1Colorado Fetal Care Center, the Heart Institute, the Department of Pediatrics, and the TeleHealth Department, Children's Hospital Colorado, and the University of Colorado School of Medicine, Aurora, and St. Mary's Medical Center, Grand Junction, Colorado; the Department of Pediatrics, Children's Hospital of Wisconsin; Milwaukee Wisconsin; and the Department of Biostatistics and Informatics, University of Colorado, Aurora, Colorado.
Fetal telecardiology improved access to care in underserved areas, offering accurate diagnoses and high patient satisfaction without sacrificing quality. This program provided significant economic benefits to families by reducing travel costs.
Area of Science:
- Cardiology
- Medical Technology
- Telemedicine
Background:
- Medically underserved areas often face challenges in accessing specialized healthcare services.
- Fetal congenital heart disease requires timely diagnosis and expert consultation.
- Traditional fetal cardiac evaluations may involve significant travel for patients.
Purpose of the Study:
- To evaluate the effectiveness and feasibility of a fetal telecardiology program.
- To assess the impact of telecardiology on diagnostic accuracy, patient satisfaction, and economic factors.
- To determine the program's benefits in a medically underserved region.
Main Methods:
- A prospective case series involving pregnant women (18-38 weeks gestation) with risk factors for fetal congenital heart disease.
- Local obstetric ultrasonographers performed fetal echocardiograms, with real-time remote reading by a fetal cardiologist.
- Evaluation across five domains: ultrasonographer education, process efficiency, patient satisfaction, economic effects, and diagnostic accuracy.
Main Results:
- Obstetric ultrasonographers showed improved identification of fetal congenital heart disease after initial training.
- A total of 455 telecardiology examinations were performed over 37 months.
- Mothers preferred local evaluations; telecardiology was nine times more cost-effective than traveling to a distant center ($61 vs $581).
- Diagnosed congenital heart disease in 28 fetuses and arrhythmia in 15, with one false-negative. All fetuses were correctly risk-stratified.
Conclusions:
- Fetal telecardiology maintained diagnostic quality and patient satisfaction.
- The program proved feasible, empowering local providers and offering economic advantages.
- Timely, standard-of-care consultations were provided without the need for patient travel.
