AI-Enabled regional tele-ECG cloud platform and improving access to cardiovascular diagnosis: real-world evidence...

Significant disparities in cardiovascular disease outcomes persist between urban centers and resource-constrained primary healthcare (PHC) settings due to geographic barriers and uneven access to specialist expertise. Digital health networks offer a potential strategy to improve diagnostic accessibility. This study evaluated the real-world implementation of an AI-enabled regional tele-ECG cloud platform within an integrated urban medical group.

A longitudinal real-world evaluation was conducted using 1,998 tele-ECG transmissions, including 53 confirmed myocardial infarction (MI) cases at the PHC level within a network of 1,166 MI patients. The platform integrated AI-assisted ECG interpretation with centralized specialist review through a cloud-based B/S architecture. Analyses included inter-tier comparisons, subgroup analyses by geographic location and age (≥65 years), post-hoc power assessment, and a Budget Impact Analysis (BIA) with sensitivity analysis.

Platform implementation was associated with reduced delays in emergency cardiovascular care. Among patients presenting with chest pain at PHC institutions, median clinical decision-making time decreased from 10 to 3 min (70.0% reduction), while report turnaround time (TAT) was 3.79 ± 1.81 min. No significant differences were observed between PHC institutions and the tertiary hospital in TAT (P = 0.4384) or report review times (P = 0.8102). Diagnostic accuracy at the PHC level increased from 82.30% to 98.11%. PHC institutions achieved a survival-to-discharge rate of 75.00% among acute MI cases. The BIA showed an average patient saving of 26 CNY per encounter and an annual net social benefit of 154,182.50 CNY for the regional network.

The AI-enabled regional collaborative model was associated with improved access to cardiovascular diagnosis across geographically diverse settings. Despite limited statistical power in the PHC subgroup (mean power: 32.4%) and potential confounding from seasonal population migration, the platform may provide a scalable approach for strengthening cardiovascular diagnostic capacity in resource-constrained regions.