Tele-cardiology in Remote Areas of Saudi Arabia: Bridging Geography with Digital Cardiac Care

The cardiovascular disease (CVD) is a significant burden in Saudi Arabia, which is increased due to the geographic challenges that deter effective accessibility to specialized cardiac services by patients living in remote and rural areas [1, 2]. Tele‑cardiology can be described as the provision of services related to cardiology remotely (with the incorporation of telecommunication and digital technologies) so that it can be presented as a scalable solution to increase access to care delivery, accelerate the diagnosis (especially in the case of ST-segment elevation myocardial infarction (STEMI)) the chronic disease management (heart failure, post-myocardial infarction follow-up, and arrhythmia detection), and unnecessary inter-hospital transfers can be reduced [3, 5]. Efforts in national telehealth in the Kingdom have seen a rapid growth with incidents like the Seha Virtual Hospital, the 937 Call Center, that have been implemented in the transformation programme of the Vision 2030 Health Sector [6, 7]. However, there are still significant challenges and these include connectivity gaps between remote areas, lack of workforce training, lack of interoperability between devices and information technology (IT) systems, uncertainties in law and regulatory systems, uncertainty over reimbursement models, and cultural barriers as well as digital illiteracy [2, 8]. Randomized controlled trials, meta-analyses and region-specific pilot programmes train the evidence and prove the heterogeneous but promising results. Organised distance care has been demonstrated to decrease hospitalisation among heart failure patients as well as to improve process metrics including door-to-device times and triage effectiveness of acute coronary syndrome [4, 5, 9]. However, numerous studies have not consistently found benefit in hard clinical endpoints hence highlighting the need to thoroughly design programmes, make highly accurate target-population selection and incorporate efficient technology-use [9, 10]. Digital and network infrastructure fortification, specifically by expanding 5G and wireless coverage, scaling tele-echocardiography and pre-hospital transmission of electrocardiograms (ECG) and echocardiography, standardisation of clinical protocols and data governance, training in allied health professionals, integrating artificial intelligence (AI) based ECG and echocardiographic triage systems, and connecting tele-cardiology services with national cardiovascular registries and emergency response networks should be top in the list of strategic priorities [3, 6, 7]. This review summarises the existing evidence, describes the current local activities and regulations, presents the main obstacles to the implementation, and provides the practical recommendations to the further development of tele-cardiology in the remote Saudi Arabian territories.