Upscaling a regional telecardiology service to a nationwide coverage and beyond: the experience of the Telehealth Network of Minas Gerais.

Cardiovascular diseases are the leading cause of death globally and in Brazil. The provision of quality healthcare faces challenges due to resource scarcity and unequal distribution, particularly affecting rural areas. Telehealth strategies have shown potential to address these challenges by improving access to specialised care. The Telehealth Network of Minas Gerais (TNMG) is a large-scale Brazilian public telehealth service, established in 2005 to provide telecardiology support to primary healthcare teams. Positive outcomes led to its expansion. Currently, the TNMG provides telecardiology support for 14 out of the 27 states and 1320 municipalities in Brazil, 72.1% of those with up to 20 000 inhabitants. Between 2006 and 2024, more than 9 million ECG reports were issued by the TNMG. Operational aspects include 24/7 availability, with elective ECG reports issued in a median of 41 min 30 s (Q1=6 min 44 s, Q3=1 h 32 min 24 s) and emergency reports in 47 s (Q1=22 s, Q3=1 min 55 s). Clinical alerts notify urgent conditions, facilitating timely interventions. Synchronous eConsults service support local primary care-based physicians, promoting collaborative care. TNMG's telecardiology system has facilitated scientific and technological advancements, including machine learning applications for ECG interpretation and prognostic implications. International collaborations have expanded, with ongoing projects in Africa and partnerships with prestigious institutions worldwide. Future directions involve integrating artificial intelligence (AI) algorithms into the telecardiology service to improve efficiency and prioritise critical cases. AI offers promising opportunities for enhancing medical ECG reporting and sustaining the effectiveness of telehealth services.