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Tele-Electrocardiography and Mortality: Clinical Outcomes in Digital Electrocardiography Cohort–Data from Belo Horizonte, Brazil (CODE-BH) Cover

Tele-Electrocardiography and Mortality: Clinical Outcomes in Digital Electrocardiography Cohort–Data from Belo Horizonte, Brazil (CODE-BH)

Global Heart
Volume 21 (2026): Issue 1
By: ,  ,  ,   and    
Open Access
|May 2026
Figures & tables

Figures & Tables

Infographic titled ‘Tele-electrocardiography and mortality: CODE BH cohort study, Brazil’ with three sections. Context section includes an illustration of a heart with ECG waveform and text explaining that cardiovascular diseases are the leading cause of mortality and that ECG has a vital diagnostic and prognostic role. Study design section shows a map of Brazil highlighting Belo Horizonte and icons of people, describing an electronic cohort of ECGs performed in primary care settings with 337,021 patients with mean age 54.4 years (38.2% male). Main results section presents statistical findings: ECG abnormality is associated with higher risk of mortality and cardiovascular hospitalization
Figure 1

Flowchart of the data processing and patient selection procedures for the CODE and CODE-BH cohorts.

Table 1

Clinical characteristics of CODE-BH patients, according to the Minnesota code.

VARIABLE n;(%)NORMAL ECG n = 124,816MINOR ECG ABNORMALITY n = 132,266MAJOR ECG ABNORMALITY n = 79,939GLOBAL p-VALUENORMAL VS MINOR p-VALUENORMAL VS MAJOR p-VALUEMINOR VS MAJOR p-VALUE
Age
(mean, SD)		48.7
(16.4)		52
(18.1)		58.2
(18.3)		<0.001<0.001<0.001<0.001
Gender<0.001<0.001<0.001<0.001
Female84,428
(67.6)		76,629
(57.9)		47,566
(59.5)
Male40,388
(32.4)		55,637
(42.1)		32,373
(40.5)
Hypertension32,679
(45.0)		40,264
(54.1)		28,727
(63.7)		<0.001<0.001<0.001<0.001
Diabetes13,867
(11.1)		17,667
(13.4)		13,200
(16.5)		<0.001<0.001<0.001<0.001
Smoking9,015
(7.2)		9,777
(7.4)		5,638
(7.1)		0.010.100.150.004
Dyslipidemia8,286
(6.6)		10,039
(7.6)		7,554
(9.4)		<0.001<0.001<0.001<0.001
MI1,238
(1.0)		1,767
(1.3)		2,411
(3.0)		<0.001<0.001<0.001<0.001
Chagas disease508
(0.4)		589
(0.4)		817
(1.0)		<0.0010.14<0.001<0.001
COPD1,276
(1.0)		1,381
(1.0)		1,009
(1.3)		<0.0010.60<0.001<0.001

[i] Data are presented as mean(SD) or number (%).

COPD: Chronic obstructive pulmonary disease, MI: Myocardial infarction.

Table 2

Prevalence of ECG major abnormality by gender.

MAJOR ABNORMALITYN (%)FEMALE (%)MALE (%)
Ischemic79,000 (71.7)47,856 (60.6)31,144 (39.4)
ST segment39,075 (35.5)23,766 (60.8)15,309 (39.2)
q wave36,270 (32.9)22,065 (60.8)14,205 (39.2)
q wave + ST segment3,655 (3.3)2,025 (55.4)1,630 (44.6)
IV conduction15,555 (14.1)8,438 (54.2)7,117 (45.8)
RBBB7,599 (6.9)3,779 (49.7))3,820 (50.3)
LBBB4,785 (4.3)3,082 (64.4)1,703 (35.6)
Nonspecific BBB3,171 (2.9)1,577 (49.7)1,594 (50.3)
Arrhythmia7,302 (6.7)3,841 (52.6)3,463 (47.4)
AF/Flutter7,089 (6.5)3,720 (52.5)3,369 (47.5)
SVT13 (0.0)7 (53.8)6 (46.2)
LVH with ST-segment abnormalities5,568 (5.1)2,993 (53.8)2,575 (46.2)
Miscellaneous2,178 (2.0)1,217 (55.9)961 (44.1)
Pacemaker1,872 (1.7)1,050 (56.1)822 (43.9)
WPW306 (0.3)167 (54.6)139 (45.4)
AV conduction413 (0.3)252 (61.0)161 (39.0)
Second and third-degree AVB413 (0.3)252 (61.0)161 (39.0)

[i] AF: atrial fibrillation, AV: atrioventricular, AVB: atrioventricular block, BBB: bundle branch block, IV: intraventricular, LBBB: left bundle branch block, LVH: left ventricular hypertrophy, RBBB: right bundle branch block, SVT: supraventricular tachycardia, WPW: Wolf-Parkinson-White.

Table 3

Clinical and ECG characteristics of CODE-BH patients by mortality (a) and cardiovascular hospitalization (b).

A). MORTALITY
VARIABLE n (%)NON MORTALITYMORTALITYP-VALUE
Age (mean, SD)51.7 (17.8)67.8 (14.0)<0.001
Sex<0.001
Female202,689 (62.3)5,933 (51.5)
Male122,814 (37.7)5,585 (48.5)
Hypertension96,203 (52.3)5,467 (66.7)<0.001
Diabetes42,402 (13.0)2,332 (20.2)<0.001
Smoking23,316 (7.2)1,114 (9.7)<0.001
Dyslipidemia24,799 (7.6)1,080 (9.4)<0.001
MI4,615 (1.4)346 (3.0)<0.001
Chagas disease1,319 (0.4)93 (0.8)<0.001
COPD3,014 (0.9)194 (1.7)<0.001
ECG<0.001
Normal122,727 (37.7)2,089 (18.1)
Minor128,155 (39.4)4,111 (35.7)
Major74,621 (22.9)5,318 (46.2)
B). CARDIOVASCULAR HOSPITALIZATION
VARIABLE n (%)NON HOSPITALIZATIONHOSPITALIZATIONP-VALUE
Age (mean, SD)52.0 (17.9)64.0 (13.1)<0.001
Sex<0.001
Female204,534 (62.3)4,088 (47.9)
Male123,948 (37.7)4,451 (52.1)
Hypertension97,617 (52.3)4,053 (74.6)<0.001
Diabetes42,791 (13.0)1,943 (22.8)<0.001
Smoking23,615 (7.2)815 (9.5)<0.001
Dyslipidemia24,520 (7.5)1,359 (15.9)<0.001
MI4,210 (1.3)751 (8.8)<0.001
Chagas disease1,335 (0.4)77 (0.9)<0.001
COPD3,111 (0.9)97 (1.1)0.08
ECG<0.001
Normal123,398 (37.6)1,418 (16.6)
Minor129,631 (39.5)2,635 (30.9)
Major75,453 (23.0)4,486 (52.5)

[i] COPD: Chronic obstructive pulmonary disease, MI: Myocardial infarction.

Table 4

Risk for mortality and cardiovascular hospitalization in CODE-BH cohort, according to ECG abnormality.

MORTALITYHOSPITALIZATION
MODELECG ABNORMALITYHR (95% CI)p-VALUEHR (95% CI)p-VALUE
UnadjustedMinor1.87
(1.77–1.97)		<0.0011.76
(1.65–1.88)		<0.001
Major4.01
(3.81- 4.22)		<0.0014.90
(4.62- 5.20)		<0.001
Adjusted by age and genderMinor1.43
(1.35–1.50)		<0.0011.47
(1.37–1.56)		<0.001
Major2.24
(2.13–2.36)		<0.0013.36
(3.16–3.58)		<0.001
Adjusted by comorbidities*Minor1.45
(1.36–1.54)		<0.0011.39
(1.28–1.50)		<0.001
Major2.30
(2.16–2.44)		<0.0013.12
(2.89–3.37)		<0.001

[i] *Hypertension, diabetes, smoking, dyslipidemia, myocardial infarction, Chagas disease, and chronic obstructive pulmonary disease.

Figure 2

Kaplan-Meier survival curves, according to the ECG abnormality.

DOI: https://doi.org/10.5334/gh.1554 | Journal eISSN: 2211-8179
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Language: English
Page range: 42 - 42
Submitted on: Jun 23, 2025
Accepted on: Apr 28, 2026
Published on: May 22, 2026
Published by: Ubiquity Press
In partnership with: Paradigm Publishing Services
Publication frequency: 1 issue per year
Keywords:
electrocardiogram,
electronic cohort,
cardiovascular hospitalization,
mortality

© 2026 Gabriela Miana de Mattos Paixão, Carla Paula Moreira Soares, Paulo Gomes Rodrigues, Peter W. Macfarlane, Antonio Luiz P. Ribeiro, published by Ubiquity Press
This work is licensed under the Creative Commons Attribution 4.0 License.

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