Role of telemedicine in cardiovascular care in low- and middle-income countries (LMICs)

With an anticipated 19.2 million deaths in 2023, cardiovascular diseases (CVDs) continue to be the leading cause of death worldwide, with most of these deaths occurring in low- and middle-income countries (LMICs). In areas like Southeast Asia and sub-Saharan Africa, the incidence of CVD has increased by up to 50% over the past three decades due to fast epidemiological transformation, but LMIC health systems still confront significant challenges in long-term care, diagnosis, and prevention. One promising approach to filling these gaps is telemedicine, which the WHO defines as the use of information and communication technology to provide clinical care and health services over long distances. Technological developments in wearable technology, teleconsultation, remote monitoring, and mobile health (mHealth) have shown promise for expanding access to specialized cardiovascular services, improving continuity of care, and assisting in the early detection of high-risk illnesses. However, there are still significant questions about telemedicine's affordability, sustainability, accessibility, and fair scaling up in environments with limited resources. This review explores the current role of telemedicine in cardiovascular care across LMICs by summarizing available evidence, implementation experiences, and context-specific challenges. While highlighting successful models like smartphone-based tele management, tele-ECG networks, telerehabilitation, and remote physiologic monitoring, it also identifies significant obstacles like manpower shortages, financial limits, digital injustices, and infrastructure limitations. This review aims to explore the current role of telemedicine in cardiovascular care in LMICs by examining available evidence, implementation experiences, clinical applications, and challenges to its effective integration into health systems.