ABC | Volume 113, Nº5, November 2019

Guidelines Guideline of the Brazilian Society of Cardiology on Telemedicine in Cardiology – 2019 Arq Bras Cardiol. 2019; 113(5):1006-1056 Content Presentation .........................................................................................1012 Introduction ..........................................................................................1013 1. Fundamentals of Telemedicine: Concepts, Bioethical Aspects, Legislation and Regulation, Applicability in Brazil, and Artificial Intelligence ...........................................................................................1014 1.1. Fundamentals of Telemedicine .........................................................1014 1.2. Types of Intervention in Telehealth ....................................................1014 1.3. Safe Bases for Data Transmission ....................................................1014 1.4. Data Protection and Confidentiality ..................................................1014 1.5. Bioethical Aspects ............................................................................1015 1.6. Legislation and Regulation in Brazil ..................................................1016 1.6.1. The Brazilian Internet Civil Framework ........................................1016 1.6.2. General Law Data Protection Law .................................................1016 1.6.3. Regulation on Telemedicine by the Federal Council of Medicine ......1017 1.7. Applicability in Brazil .........................................................................1017 1.7.1. Concept of Urban and Rural Territories and Remote Area ...........1017 1.7.2. Medical Demography ...................................................................1017 1.7.3. eHealth Strategy ...........................................................................1019 1.7.4. Telecommunications and Data Infrastructure ..............................1019 1.8. Artificial Intelligence .........................................................................1019 2. Uses and Application of Telemedicine in Cardiology .................1023 2.1. Telemedicine in Brazil .......................................................................1023 2.2. In Primary Care .................................................................................1023 2.2.1. Applications in Health Promotion and Prevention .......................1023 2.2.2. Decision Support Systems ............................................................1024 2.2.3. Teleconsulting ...............................................................................1024 2.2.4. Teleregulation ...............................................................................1024 2.2.5. Telediagnosis ................................................................................1024 2.2.6. Tele-Education ..............................................................................1025 2.7. In Specialized Care ............................................................................1026 2.7.1. Heart Failure .................................................................................1026 2.7.2. In Hypertension ............................................................................1027 2.7.3. Emergency Services ......................................................................1028 2.7.4. In Systems of Care for Acute Myocardial Infarction .....................1028 2.7.5. In Controlling the Use of Anticoagulants .....................................1028 2.7.6. Cardiac Rehabilitation ..................................................................1028 2.7.7. Remote Monitoring by Implantable Devices ................................1029 2.7.8. Atrial Fibrillation ...........................................................................1029 2.7.9. Channelopathies ...........................................................................1030 2.7.10. Tachycardia and Ventricular Fibrillation .....................................1030 2.7.11. Congenic Heart Disease .............................................................1030 2.8. Cardiovascular Teletomography and Teleresonance ..........................1030 2.8.1. DICOM Standard ..........................................................................1030 2.8.2. MRI, CT, and Telemedicine ...........................................................1031 2.8.3. The Federal Council of Medicine and Tele-CT/Tele-MRI ..............1031 2.8.4. Imaging Transmission ...................................................................1031 2.8.5. Postprocessing Software and Workstations ..................................1031 2.8.6. Database, Communication, and Image Archiving ........................1031 2.8.7. Clinical Indications of MRI and CT ...............................................1031 3. Telerobotics Applied to Cardiology ...............................................1031 3.1. Robotic Telesurgery ..........................................................................1031 3.2. Robotic Angioplasty ..........................................................................1034 4. Telemedicine for Provision of Service and in Supplementary Health ....................................................................................................1034 4.1. Provision of Services .........................................................................1034 4.2. Telemedicine in Supplementary Health .............................................1035 5. Economic Evaluation and Budgetary Impact of the Incorporation of Telemedicine in Cardiology in Brazil ............................................1036 5.1. Concepts of Economic Evaluation in Telemedicine ............................1036 5.2. Applied Economic Methods ...............................................................1036 5.3. Literature Review ..............................................................................1037 5.4. Economic Evaluations of Telemedicine in Brazil ................................1041 5.5. InCor-FMUSP Telemedicine and Patient Monitoring Service ..............1041 5.6. Telediagnosis and Teleconsultation System of the Minas Gerais Teleassistance Network (Rede de Teleassistência de Minas Gerais, RTMG) at the Clinics Hospital of UFMG ....................................................................1042 5.7. Analysis of the Economic Impact of the TelessaúdeRS Teleconsulting Service .....................................................................................................1043 6. Recommendations ..........................................................................1044 References ............................................................................................1046 1011