Combined remote monitoring, consultation reduces CV death, hospitalizations in HF
Telemedicine interventions that include remote disease monitoring and remote consultations may reduce short-term CV-related hospitalization and death risk among adults with HF, researchers reported in a meta-analysis.
“We found reduced cardiovascular-related mortality and hospitalization for patients with heart failure who received combined remote telemedicine monitoring and consultation compared with usual care,” Atul Anand, PhD, a senior clinical research fellow at the British Heart Foundation (BHF) Centre for Cardiovascular Science, University of Edinburgh, Scotland, and colleagues wrote in The Lancet Digital Health. “This effect was not observed by simple remote access to a health care professional without additional monitoring data. Reductions in cardiovascular-related hospitalization were only observed in cohorts with heart failure with short-term follow-up and were driven by early reductions within 12 months of telemedicine intervention. No telemedicine intervention was shown to alter risk of all-cause hospitalization or [all-cause] mortality.”
Anand and colleagues analyzed data from 34 randomized controlled trials, observational studies or cohort studies with 13,269 participants that evaluated the effects of a telemedicine intervention on CV outcomes for people at risk for CVD or with established CVD, with half assigned to a telemedicine intervention and half assigned to usual care. Researchers classified telemedicine interventions into one of four groups as defined by WHO: remote consultation, remote monitoring, medical data transmission and consultations for case management between health care providers (remote case management). Follow-up ranged from 3 to 79 months, with 62% of studies reporting short-term outcomes within 12 months of a telemedicine intervention and 65% of studies including participants with HF.
The primary outcome was CV death; secondary outcomes included hospitalization secondary to CV causes, all-cause mortality and all-cause hospitalization.
Researchers found that combined remote monitoring and consultation for patients with HF was associated with reduced risk for CV mortality (RR = 0.83; 95% CI, 0.7-0.99; P = .036) and CV hospitalization (RR = 0.71; 95% CI, 0.58-0.97; P = .0002); this effect was mostly in studies with short-term follow-up.
There was no effect of telemedicine on all-cause hospitalization (RR = 1.02; 95% CI, 0.94-1.1; P = .71) or all-cause death (RR = 0.9; 95% CI, 0.77-1.06; P = .23) and no benefits with remote consultation in isolation.
Researchers also observed small reductions in systolic BP (mean difference, –3.59 mm Hg; 95% CI, –5.35 to –1.83; P < .0001) with remote monitoring and consultation in secondary prevention populations.
“Our findings suggest a definite role for telemedicine in the management of heart failure, when combining both remote monitoring and patient consultation to optimize treatments and personalized advice for patients,” the researchers wrote. “Telemedicine was associated with reduced cardiovascular mortality and hospitalization. Small gains in the management of cardiovascular risk factors might be achievable with telemedicine interventions, but there is less certainty for effectiveness in populations of patients with cardiovascular disease but without heart failure.”
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