Telemedicine for patients with cardiovascular diseases

According to the report Telehealth: Mapping the Evidence for Patient Outcomes From Systematic Reviews [1] by the Pacific Northwest Evidence-based Practice Center, cardiovascular disease is the main clinical focus area (21% of all studies) for the application of telemedicine tools. Telehealth report summarizes the evidence from twelve published studies [2–13].

Communication and Counseling

Two systematic reviews [6,13] displayed opposite results in regard to telehealth intervention in communication and counseling for cardiovascular diseases. One of the reviews [6], which included 13 included papers, showed there is no evidence that telehealth interventions can reduce smoking habits or the risk for cardiovascular diseases. Also, no effect of telehealth intervention on increasing levels of high-density lipoproteins cholesterol was discovered. The other systematic review and meta-analysis [13] found that, compared to usual care, telehealth instruments (digital health interventions) have a profitable effect on the outcomes of cardiovascular diseases (cardiovascular events, hospitalizations, and all-cause mortality) in higher-risk populations.

Remote Patient Monitoring

Five studies [11,14–17] showed a positive effect of telehealth tools in remote patient monitoring (home telehealth or telemonitoring, remote monitoring, remote patients’ management in various settings). According to one study [14], remote monitoring has the potential benefit of notification of acute clinical and medical device related events, and can reduce resource consumption. The use of telemonitoring can decrease mortality [11,15,16], reduce hospitalizations [7,11,15,16] and lengths of hospital stays [7, 15,16] and lower the number of Emergency Department visits [16] in patients with heart failure. Also, there is evidence that telemonitoring can improve patients’ satisfaction compared to usual care.

Consultations

Only one systematic review and meta-analysis [17] identified a potentially beneficial effect of consultation telehealth tools on mortality associated with acute myocardial infarction.

Telerehabilitation

One study [18] stated that the use of telehealth tools and hospital-based programs has an equal effect on health outcomes (reduction in cardiovascular disease risk factors) and cost-effectiveness.

References

1. Totten AM, Womack DM, Eden KB, McDonagh MS, Griffin JC, Grusing S, Hersh WR. Telehealth: Mapping the Evidence for Patient Outcomes From Systematic Reviews. Agency for Healthcare Research and Quality (US); 2016.
2. Chaudhry SI, Phillips CO, Stewart SS, Riegel B, Mattera JA, Jerant AF, Krumholz HM. Telemonitoring for patients with chronic heart failure: a systematic review. J Card Fail. 2007 Feb;13(1):56–62.
3. Clarke M, Shah A, Sharma U. Systematic review of studies on telemonitoring of patients with congestive heart failure: a meta-analysis. J Telemed Telecare. 2011 Jan 1;17(1):7–14.
4. Dang S, Dimmick S, Kelkar G. Evaluating the Evidence Base for the Use of Home Telehealth Remote Monitoring in Elderly with Heart Failure. Telemed e-Health. 2009 Oct;15(8):783–96.
5. de Waure C, Cadeddu C, Gualano MR, Ricciardi W. Telemedicine for the Reduction of Myocardial Infarction Mortality: A Systematic Review and a Meta-analysis of Published Studies. Telemed e-Health. 2012 Jun;18(5):323–8.
6. Merriel SWD, Andrews V, Salisbury C. Telehealth interventions for primary prevention of cardiovascular disease: A systematic review and meta-analysis. Prev Med (Baltim). 2014 Jul;64:88–95.
7. Seto E. Cost Comparison Between Telemonitoring and Usual Care of Heart Failure: A Systematic Review. Telemed e-Health. 2008 Sep;14(7):679–86.
8. Conway A, Inglis SC, Clark RA. Effective Technologies for Noninvasive Remote Monitoring in Heart Failure. Telemed e-Health. 2014 Jun;20(6):531–8.
9. Clark RA, Conway A, Poulsen V, Keech W, Tirimacco R, Tideman P. Alternative models of cardiac rehabilitation: A systematic review. Eur J Prev Cardiol. 2015 Jan 1;22(1):35–74.
10. Devi R, Singh SJ, Powell J, Fulton EA, Igbinedion E, Rees K. Internet-based interventions for the secondary prevention of coronary heart disease. Cochrane database Syst Rev. 2015 Dec 22;(12):CD009386.
11. Kotb A, Cameron C, Hsieh S, Wells G. Comparative effectiveness of different forms of telemedicine for individuals with heart failure (HF): a systematic review and network meta-analysis. PLoS One. 2015;10(2):e0118681.
12. Parthiban N, Esterman A, Mahajan R, Twomey DJ, Pathak RK, Lau DH, Roberts-Thomson KC, Young GD, Sanders P, Ganesan AN. Remote Monitoring of Implantable Cardioverter-Defibrillators. J Am Coll Cardiol. 2015 Jun;65(24):2591–600.
13. Widmer RJ, Collins NM, Collins CS, West CP, Lerman LO, Lerman A. Digital health interventions for the prevention of cardiovascular disease: a systematic review and meta-analysis. Mayo Clin Proc. 2015 Apr;90(4):469–80.
14. Parthiban N, Esterman A, Mahajan R, Twomey DJ, Pathak RK, Lau DH, Roberts-Thomson KC, Young GD, Sanders P, Ganesan AN. Remote Monitoring of Implantable Cardioverter-Defibrillators: A Systematic Review and Meta-Analysis of Clinical Outcomes. J Am Coll Cardiol. 2015 Jun 23;65(24):2591–600.
15. Conway A, Inglis SC, Clark RA. Effective technologies for noninvasive remote monitoring in heart failure. Telemed J E Health. 2014 Jun;20(6):531–8.
16. Dang S, Dimmick S, Kelkar G. Evaluating the evidence base for the use of home telehealth remote monitoring in elderly with heart failure. Telemed J E Health. 2009 Oct;15(8):783–96.
17. de Waure C, Cadeddu C, Gualano MR, Ricciardi W. Telemedicine for the reduction of myocardial infarction mortality: a systematic review and a meta-analysis of published studies. Telemed J E Health. 2012 Jun;18(5):323–8.
18. Clark RA, Conway A, Poulsen V, Keech W, Tirimacco R, Tideman P. Alternative models of cardiac rehabilitation: a systematic review. Eur J Prev Cardiol. 2015 Jan;22(1):35–74.

Submitted by Ilya Ivlev, M.D. Ph.D.