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 Table 6.1 – Recommendations for the practice of Telemedicine in Brazil Clinical indication Class of indication Level of evidence references Teleconsultation Teleconsultation assists general practitioners from remote areas in the clinical evaluation of patients with suspected or established cardiovascular disease, being cost-effective from the SUS perspective IIa B 76,99,100,101,278,279, 280,281,282 Teleconsultation assists physicians working in emergency care in the management of cases of acute cardiovascular diseases IIa C 133,134,137,138,139,140, 141,142,143,144,145,149 Teleconsultation assists in regulating access to specialized care in patients with suspected or established cardiovascular disease IIa C 101,102,103,104 Telediagnosis Tele-electrocardiography is a feasible and effective alternative to offer electrocardiography in health care systems, and is particularly useful and cost effective in primary care and remote locations I B 61,105,106,107,278 Telemedicine with transmission of electrocardiographic report in pre-hospital care of patients with suspected acute myocardial infarction reduces cardiovascular outcomes and early and late mortality I B 87,137,138,139,140,141, 142,143,144,145, Tele-echocardiography with teleconsultation is effective in the early detection of congenital heart disease in newborns IIa B 182,183,306 Tele-echocardiography allows the early detection of subclinical cases of rheumatic heart disease in children and adolescents IIa B 111,112,307 Tele-echocardiography in primary care allows early detection of cases of heart disease and may help prioritize referrals to specialized care. IIb C 109,110,112,114 Transmission of tomography and cardiac resonance imaging by telemedicine can be performed: - to obtain a second opinion IIa C 190,192 - for discussion in “Heart Teams” IIa C 190,192 - for remote support in emergency cases IIa C 190,192 - in sporadic routine cases IIa C 190,192 - for routine transmission of all cardiovascular imaging tests to specialized centers or groups IIb C 190,192 Telemonitoring Self-monitoring of blood pressure with telemonitoring helps in treatment control and adherence effective in reducing hospitalizations due to heart failure IIa B 75,77,78,127,128,129,130 Noninvasive telemonitoring strategies with structured telephone support are effective in reducing hospitalizations due to heart failure I A 115,116,118,119,120,123, 124,125,126,158,159,161 Noninvasive telemonitoring strategies with structured telephone support are effective in reducing mortality in heart failure IIa A 115,116,118,119,120,123, 124,125,126,158,159,161 Remote monitoring of patients with arrhythmias and implantable electrical devices, in addition to regular telemetric assessments, is effective in reducing outpatient visits and early detection of device dysfunction. IIa B 157,160,162,163,164,165, 166,167,168,169,170,174, 175,177,178,179,180 Telerehabilitation of eligible patients with heart failure, with or without left ventricular dysfunction, with NYHA functional class I-III, is effective in improving program adherence, quality of life and performance in the 6-minute walking distance test IIa B 148,149,150151,152 Private communication to send data or ask questions between physicians, in closed groups of specialists, or among the clinical staff of an institution or chair, safeguarding professional confidentiality I C 191 Private communication between physicians and patients through communication platforms to send data or ask questions, safeguarding professional confidentiality IIa C 191 1045