Preventative Health, Baker IDI Heart and Diabetes Institute and Faculty of Nursing, Midwifery and Health, University of Technology, Sydney, Australia.
Eur J Heart Fail. 2011 Sep;13(9):1028-40. doi: 10.1093/eurjhf/hfr039. Epub 2011 Jul 6.
Telemonitoring (TM) and structured telephone support (STS) have the potential to deliver specialized management to more patients with chronic heart failure (CHF), but their efficacy is still to be proven. The aim of this meta-analysis was to review randomized controlled trials (RCTs) of TM or STS for all-cause mortality and all-cause and CHF-related hospitalizations in patients with CHF, as a non-invasive remote model of a specialized disease-management intervention.
We searched all relevant electronic databases and search engines, hand-searched bibliographies of relevant studies, systematic reviews, and meeting abstracts. Two reviewers independently extracted all data. Randomized controlled trials comparing TM or STS to usual care in patients with CHF were included. Studies that included intensified management with additional home or clinic-visits were excluded. Primary outcomes (mortality and hospitalizations) were analysed; secondary outcomes (cost, length of stay, and quality of life) were tabulated. Thirty RCTs of STS and TM were identified (25 peer-reviewed publications (n= 8323) and five abstracts (n= 1482)). Of the 25 peer-reviewed studies, 11 evaluated TM (2710 participants), 16 evaluated STS (5613 participants) with two testing both STS and TM in separate intervention arms compared with usual care. Telemonitoring reduced all-cause mortality {risk ratio (RR) 0.66 [95% confidence interval (CI) 0.54-0.81], P< 0.0001 }and STS showed a similar, but non-significant trend [RR 0.88 (95% CI 0.76-1.01), P= 0.08]. Both TM [RR 0.79 (95% CI 0.67-0.94), P= 0.008], and STS [RR 0.77 (95% CI 0.68-0.87), P< 0.0001] reduced CHF-related hospitalizations. Both interventions improved quality of life, reduced costs, and were acceptable to patients. Improvements in prescribing, patient-knowledge and self-care, and functional class were observed.
Telemonitoring and STS both appear effective interventions to improve outcomes in patients with CHF. Systematic Review Number: Cochrane Database of Systematic Reviews. 2008:Issue 3. Art. No.: CD007228. DOI: 10.1002/14651858.CD007228.
远程监测（TM）和结构化电话支持（STS）有可能为更多慢性心力衰竭（CHF）患者提供专门的管理，但它们的疗效仍有待证明。本荟萃分析的目的是回顾 TM 或 STS 对 CHF 患者全因死亡率和全因及 CHF 相关住院的随机对照试验（RCT），作为专门疾病管理干预的非侵入性远程模型。
我们搜索了所有相关的电子数据库和搜索引擎，手工搜索了相关研究、系统评价和会议摘要的参考文献。两名审查员独立提取所有数据。纳入了比较 TM 或 STS 与 CHF 患者常规护理的 RCT。排除了包括家庭或诊所就诊次数增加的强化管理的研究。分析了主要结局（死亡率和住院率）；次要结局（成本、住院时间和生活质量）进行了列表。确定了 30 项 STS 和 TM 的 RCT（25 项同行评审出版物（n=8323）和 5 项摘要（n=1482））。在 25 项同行评审研究中，有 11 项评估 TM（2710 名参与者），16 项评估 STS（5613 名参与者），其中两项分别在单独的干预组中比较 STS 和 TM 与常规护理。远程监测降低全因死亡率{风险比（RR）0.66 [95%置信区间（CI）0.54-0.81]，P<0.0001}，STS 显示出相似但无统计学意义的趋势[RR 0.88（95% CI 0.76-1.01），P=0.08]。TM [RR 0.79（95% CI 0.67-0.94），P=0.008]和 STS [RR 0.77（95% CI 0.68-0.87），P<0.0001]均降低了 CHF 相关住院率。两种干预措施均改善了生活质量，降低了成本，并且得到了患者的认可。观察到处方、患者知识和自我护理以及功能分类的改善。
远程监测和 STS 似乎都是改善 CHF 患者结局的有效干预措施。系统评价编号：Cochrane 系统评价数据库。2008 年：第 3 期。艺术。没有。CD007228. DOI：10.1002/14651858.CD007228.
