Role of Telemedicine in Congenital Heart Disease Care Models in Low- and Middle-Income Countries: A Scientific Statement From the American Heart Association.

Telemedicine is increasingly recognized as a transformative strategy to address critical challenges in low- and middle-income countries, which comprise 63% of all nations, 84% of the global population, and 90% of children <15 years of age. These regions experience multiple barriers, including geographic remoteness, economic constraints, limited healthcare infrastructure, and a shortage of trained healthcare professionals. Congenital heart disease, a highly specialized field often centralized in urban centers, is particularly affected, leaving many children without timely or equitable access to life-saving care. In this context, telecardiology has emerged as a valuable tool across the congenital heart disease care continuum, supporting prehospital assessment, inpatient management, postdischarge follow-up, and multidisciplinary collaboration. Beyond video consultations, telemedicine enables secure transmission of electrocardiograms, echocardiograms, advanced imaging, and digital auscultation data. Artificial intelligence-based tools further enhance education, diagnostic support, and quality assurance in image acquisition. Together, these capabilities reduce unnecessary travel, expedite specialist input, strengthen local decision-making, and contribute to improved outcomes. Telemedicine also facilitates collaboration among pediatric cardiologists, neonatologists, intensivists, imaging specialists, and nurses, fostering more integrated and resilient care networks that link peripheral facilities with tertiary centers. By optimizing limited resources and expanding specialist reach, telemedicine holds significant promise for improving access, equity, and outcomes in congenital heart disease care across low- and middle-income countries. Continued investment, strategic planning, and collaborative capacity-building will be essential to ensure its sustainable and effective implementation worldwide.