Tele-ECG collaboration between tertiary and primary care in Singapore: Outcomes and learning over a 6-year period

An electrocardiogram (ECG) is the mainstay of cardiac evaluation available in primary care, after which assessment in relation to clinical symptoms and signs is made by family physicians to assess the patients holistically. Subsequently, based on this clinical evaluation, patients may then be referred for tertiary review at a cardiology department or managed in primary care. In Singapore, ECG abnormalities found in asymptomatic patients may require a specialist review and thus make up a substantial number of patients referred by primary care physicians from public healthcare polyclinics to cardiology outpatient clinics. Some of these patients may be clinically managed in primary care with no further evaluation necessary, yet others may require a non-urgent or expedited review.