Applied Cachexia Research, Department of Cardiology, Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany.
Lancet. 2011 Aug 20;378(9792):731-9. doi: 10.1016/S0140-6736(11)61229-4.
Advances in telecommunication technologies have created new opportunities to provide telemedical care as an adjunct to medical management of patients with heart failure. Meta-analyses suggest that telemedicine can reduce morbidity and mortality in such patients; however, two prospective clinical trials not included in the analyses do not support these findings. Therefore, the effectiveness of telemedicine in heart failure is not established. Telemedicine approaches range from computer-based support systems to programmes led by nurses and physicians. Standardisation and appropriate classification of telemedical systems are needed to enable accurate interpretation of clinical trials. Here we propose a classification of four generations of telemedicine in heart failure. Not all approaches are the same and not every patient with heart failure will need telemedicine. Crisis prevention and treatment, and stabilisation and self-empowerment of patients are focuses of telemedicine in heart failure. The profile of patients who can potentially benefit from telemedicine is unknown and should be investigated in adequately powered randomised clinical trials. We are optimistic that telemedicine is an efficient approach and will become an important feature of management in heart failure.
电信技术的进步为提供远程医疗创造了新的机会，可作为心力衰竭患者医疗管理的辅助手段。荟萃分析表明，远程医疗可以降低此类患者的发病率和死亡率；然而，分析中未包括的两项前瞻性临床试验并不支持这些发现。因此，远程医疗在心力衰竭中的有效性尚未确定。远程医疗方法范围从基于计算机的支持系统到由护士和医生领导的计划。需要对远程医疗系统进行标准化和适当分类，以能够准确解释临床试验。在这里，我们提出了心力衰竭远程医疗的四代分类。并非所有方法都是相同的，并非每个心力衰竭患者都需要远程医疗。远程医疗的重点是预防和治疗危机，以及稳定和增强患者的能力。可能受益于远程医疗的患者的特征尚不清楚，应在充分的随机临床试验中进行调查。我们乐观地认为，远程医疗是一种有效的方法，将成为心力衰竭管理的重要特征。
