Abstract
Background
Telemedicine is increasingly supporting chronic disease management through remote patient monitoring and consultation, particularly during the COVID-19 pandemic. We undertook a systematic review and meta-analysis of studies reporting effectiveness of telemedicine interventions for the management of patients with cardiovascular conditions.
Methods
We conducted a systematic search of PubMed, Scopus and the Cochrane Library from inception to 18 January 2021. Two reviewers independently assessed and extracted data from trials, observational and cohort studies that included a telemedicine intervention compared to usual care in cardiovascular disease populations, for outcomes of mortality, hospitalisation and risk factor modification. Study quality was evaluated by Cochrane Risk-of-Bias and Newcastle-Ottawa Scales. The systematic review protocol was registered (PROSPERO CRD42021221010).
Findings
72 studies including 127,869 participants met eligibility criteria, with 34 studies included in meta-analysis (n=13,269 with 6,620 receiving telemedicine). Remote monitoring and consultation for heart failure patients was associated with reduced risk of cardiovascular mortality (Risk Ratio [RR] 0·83, 95% Confidence Interval [CI] 0·70–0·99, p=0·04) and hospitalisation for a cardiovascular cause (RR 0·71, 95% CI 0·58–0·87, p=0·001), notably in studies with short-term follow-up. There was no effect of telemedicine on all-cause hospitalisation (RR 1.02, 95% CI 0.94–1.10, p=0.71) or mortality (RR 0.90, 95% CI 0.77–1.06, p=0.23) in these groups, and no benefits were observed with remote consultation in isolation. Small reductions were observed for systolic blood pressure (mean difference –3·59 mmHg, 95% CI –5·35 to –1·83 mmHg, p<0·001) by remote monitoring and consultation in secondary prevention populations, and in body mass index (mean difference –0·38 kg/m2, 95% CI –0·66 to –0·11 kg/m2, p=0·006) by remote consultation in primary prevention settings.
Interpretation
Telemedicine including both remote disease monitoring and consultation may reduce short-term cardiovascular hospitalisation and mortality risk amongst patients with heart failure. Future research should evaluate the sustained effects of telemedicine interventions.
Telemedicine is increasingly supporting chronic disease management through remote patient monitoring and consultation, particularly during the COVID-19 pandemic. We undertook a systematic review and meta-analysis of studies reporting effectiveness of telemedicine interventions for the management of patients with cardiovascular conditions.
Methods
We conducted a systematic search of PubMed, Scopus and the Cochrane Library from inception to 18 January 2021. Two reviewers independently assessed and extracted data from trials, observational and cohort studies that included a telemedicine intervention compared to usual care in cardiovascular disease populations, for outcomes of mortality, hospitalisation and risk factor modification. Study quality was evaluated by Cochrane Risk-of-Bias and Newcastle-Ottawa Scales. The systematic review protocol was registered (PROSPERO CRD42021221010).
Findings
72 studies including 127,869 participants met eligibility criteria, with 34 studies included in meta-analysis (n=13,269 with 6,620 receiving telemedicine). Remote monitoring and consultation for heart failure patients was associated with reduced risk of cardiovascular mortality (Risk Ratio [RR] 0·83, 95% Confidence Interval [CI] 0·70–0·99, p=0·04) and hospitalisation for a cardiovascular cause (RR 0·71, 95% CI 0·58–0·87, p=0·001), notably in studies with short-term follow-up. There was no effect of telemedicine on all-cause hospitalisation (RR 1.02, 95% CI 0.94–1.10, p=0.71) or mortality (RR 0.90, 95% CI 0.77–1.06, p=0.23) in these groups, and no benefits were observed with remote consultation in isolation. Small reductions were observed for systolic blood pressure (mean difference –3·59 mmHg, 95% CI –5·35 to –1·83 mmHg, p<0·001) by remote monitoring and consultation in secondary prevention populations, and in body mass index (mean difference –0·38 kg/m2, 95% CI –0·66 to –0·11 kg/m2, p=0·006) by remote consultation in primary prevention settings.
Interpretation
Telemedicine including both remote disease monitoring and consultation may reduce short-term cardiovascular hospitalisation and mortality risk amongst patients with heart failure. Future research should evaluate the sustained effects of telemedicine interventions.
| Original language | English |
|---|---|
| Journal | The Lancet Digital Health |
| DOIs | |
| Publication status | Published - 23 Aug 2022 |
Keywords / Materials (for Non-textual outputs)
- Cardiovascular disease
- digital health
- Telemedicine