Editorial: Remote and Digital Care in Cardiologyfrom Development to Implementation

Han Feng^1*Mario Mekhael¹Duo Yu²Chanho Lim¹Hongyu Miao³Nassir Marrouche^1*

• ¹School of Medicine, Tulane University, New Orleans, United States
• ²Medical College of Wisconsin Data Science Institute, Milwaukee, United States
• ³Florida State University College of Nursing, Tallahassee, United States

Artificial intelligence (AI) may be particularly helpful in early prevention and screening stages. A large-scale machine learning study utilized algorithms such as LightGBM to analyze routine clinical and laboratory data, predicting carotid artery plaques with an AUC of 85.4%. This model eliminates the need for advanced imaging, thereby broadening access to early atherosclerosis risk stratification, particularly for underserved populations.Access and scalability are central to the promise of telemedicine. Especially in prevention, where identifying patients at risk for a certain disease is crucial for effective screening strategies. A study on at-home oscillometric blood pressure monitoring in children aged 3-17 showed that caregivers could reliably assess blood pressure, particularly in normotensive children. This supports the idea that early cardiovascular risk screening can begin at home, potentially mitigating disease progression before it reaches the clinic. Also, this can further identify subjects that may need further workup and management.Moreover, combining different tools can increase screening and diagnostic yield. For example, in rhythm diagnostics, combining wearable patch ECGs with transesophageal electrophysiology (TEPS) created a hybrid approach to evaluating palpitations of unknown origin. In patients with negative TEPS, prolonged patch monitoring identified previously undetected arrhythmias. This complementary use of non-invasive and invasive technologies demonstrates how telecardiology can extend and personalize preoperative arrhythmia workups to improve patient care. Wearables and implantable devices are rapidly becoming the backbone of outpatient cardiac monitoring. In a cohort of 108 cardiac surgery patients, a smartwatch-integrated platform tracked ECG, heart rate, and blood pressure from home. It successfully detected asymptomatic AV block and other arrhythmias with strong concordance to in-clinic assessments. These findings highlight how consumer-grade devices are expanding into clinical territory, providing scalable tools for improving outcomes.Similarly, implantable cardiac monitors augmented by the SmartECG algorithm addressed a longstanding challenge in telemonitoring: alert fatigue. The algorithm filtered nearly 43% of false detections while maintaining a low 2.6% sensitivity loss, reducing clinician review time by over 40%. This balance of precision and efficiency illustrates how AI can support sustainable, longterm arrhythmia surveillance.Likewise, the study of high-intensity interval training (HIIT) following PCI provides a framework for home-based rehabilitation. HIIT led to notable improvements in VO2 peak and 6-minute walk test performance, especially in patients with prior myocardial infarction. These physiologic gains were paralleled by shifts in gut microbiome and metabolomics, pointing toward a future of biologically informed, remotely delivered exercise interventions. Even within procedural cardiology, sensor-driven monitoring is beginning to influence care. A first clinical evaluation of a diaphragm movement sensor integrated into cryoballoon systems aimed to detect right phrenic nerve stress. While its diagnostic performance was limited, the concept reflects a growing emphasis on real-time, automated support tools that may one day enhance safety and standardization in electrophysiologic procedures. This Research Topic offers a timely perspective on the evolving role of telemedicine in cardiovascular care. While still in its early stages, the integration of remote monitoring, wearable technologies, and AI is gradually reshaping both clinical practice and research 4 . The studies highlighted here demonstrate practical, data-driven contributions from preoperative risk assessment to postoperative rehabilitation and procedural support. Rather than claiming revolution, this collection reflects steady progress: incremental yet meaningful steps toward distributed, accessible, and intelligent cardiovascular care. Importantly, these efforts are rooted in real-world contexts and designed to complement existing workflows and act as supportive tools. Admittedly, telemedicine is not intended to replace in-person interactions between patients and clinicians, but rather to extend the reach of care and ensure broader populations can benefit from available medical resources 5 . Sustainable innovation in cardiology has been shown to depend on the translation of digital health technologies into clinically actionable tools that support both clinicians and patients 6 . This Research Topic illustrates how such translation is beginning to take shape at every step of patient care.