Statewide Tele-ECG in São Paulo: A Ten-Year Program Experience (Preprint)

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BACKGROUND Introduction: Cardiovascular diseases are a leading cause of death in Brazil and globally. The 12-lead electrocardiogram (ECG) is a low-cost, non-invasive exam and widely available, but accurate interpretation might require specialized expertise. Tele-ECG can extend expert interpretation to resource-limited settings and standardize reporting workflows within public health systems in Brazil. Recognizing this important need, the InCor ECG Unit, in collaboration with the São Paulo State Department of Health (SES/SP), formalized a Tele-ECG service in São Paulo. OBJECTIVE Objective: To describe the design, scale-up, and operational metrics of a statewide Tele-ECG service providing ECG interpretation to public health units of the SES/SP over 10 years. METHODS Methods: We summarized program operations from 2016 through August 2025, including participating units, devices, monthly ECG volume, reporting times for emergency vs routine tracings, and the proportion of pre-specified critical findings using descriptive analysis only. RESULTS Results: The network expanded from 17 devices across 6 units (2016) to 44 devices across 25 units in 13 cities (August 2025). The program is currently evaluating more than 7,000 ECG exams each month. In our service, the average turnaround time for emergency in ECG reports is ≤10 minutes in 92% of cases. For non-urgent examinations, the average reporting time is no more than 2 hours in 100% of cases. CONCLUSIONS Conclusion: As Brazil faces substantial social and economic disparities, which significantly impact access to healthcare, telemedicine is an effective solution for delivering specialized care to underserved communities with limited infrastructure. This program demonstrates that a statewide Tele-ECG model integrated within a public health system is feasible and scalable. Prospective evaluations linking operational metrics to patient-level outcomes are warranted.