Sánchez Castro, Juan José AugustoVirgos Lamela, AlejandroRey Aldana, DanielMazón Ramos, PilarGude Sampedro, FranciscoGonzález Juanatey, José Ramón2026-06-032026-06-032025-12-06Castro, J. J. A. S., Virgos Lamela, A., Aldana, D. R., Mazón Ramos, P., Gude Sampedro, F., & González-Juanatey, J. R. (2026). Advanced electronic consultation between primary care and cardiology: impact of tele-echocardiography and event-based electrocardiographic monitoring. European Heart Journal Open, 6(1). https://doi.org/10.1093/EHJOPEN/OEAF1592752-4191https://hdl.handle.net/10347/47472Electronic consultation (econsultation) has proven effective in optimizing communication between primary care and cardiology, reducing waiting times and unnecessary face-to-face referrals. This study assessed the impact of incorporating tele-echocardiography and event-based electrocardiographic monitoring (EEM) into an advanced e-consultation model. A prospective observational cohort of 1200 consecutive e-consultations was analysed; in 354 cases, the advanced pathway was activated, including 300 tele-echocardiograms and 54 EEM studies. Remote resolution increased from 38.0% in the traditional model to 54.3% in the advanced model (P < 0.01). Diagnostic agreement was high (κ=0.85 for tele-echo vs. standard echo; κ =0.75 for primary care vs. cardiologist interpretation), with only 6.7% non-interpretable studies and no major adverse events during a mean follow- up of 19 months. This structured implementation of tele-echocardiography and EEM suggests a feasible, scalable, and safe innovation aligned with digital transformation goals in cardiology.eng© The Author(s) 2025. This is an Open Access article distributed under the terms of the Creative Commons Attribution LicenseAttribution 4.0 Internationalhttp://creativecommons.org/licenses/by/4.0/E-consultationTele-echocardiographyEvent-based ECG monitoringDigital cardiologyPrimary careHealthcare efficiency320501 Cardiologíajournal article10.1093/EHJOPEN/OEAF159open access