Nakamura Naoto, Koga Tadashi, Iseki Hiroshi
Cooperative Major in Advanced Biomedical Sciences, Joint Graduate School of Tokyo Women's Medical University and Waseda University, Japan.
J Telemed Telecare. 2014 Jan;20(1):11-7. doi: 10.1177/1357633X13517352. Epub 2013 Dec 18.
We carried out a meta analysis of remote patient monitoring (RPM) for chronic heart failure (CHF) patients. A literature search was used to identify randomised controlled trials with more than 40 patients, published between February 2003 and February 2013. The primary outcome (mortality) was analysed using a random effect model. Thirteen studies were included (3337 patients). RPM resulted in a significantly lower mortality (risk ratio 0.76; 95% confidence interval 0.62 to 0.93) compared to usual care. The test for heterogeneity showed that articles had been extracted homogeneously (I(2)=0%, P=0.67). In order to determine which RPM model was most effective, subgroup analyses were conducted by age, severity of illness, measurement frequency, medication management and speed of intervention. The group with rapid intervention had the lowest mortality (rapid group risk ratio=0.59, non-rapid group risk ratio=0.88, P=0.05). The group with high measurement frequency had lower mortality (high frequency group risk ratio=0.62, low frequency group risk ratio=0.89, P=0.07). The group with medication management had lower mortality (medication group risk ratio=0.65, non medication group risk ratio=0.85, P=0.19). RPM is effective in chronic heart failure and rapid intervention was the most important factor in the RPM model.
我们对慢性心力衰竭(CHF)患者的远程患者监测(RPM)进行了一项荟萃分析。通过文献检索来识别2003年2月至2013年2月期间发表的、患者超过40例的随机对照试验。使用随机效应模型分析主要结局(死亡率)。纳入了13项研究(3337例患者)。与常规护理相比,RPM导致死亡率显著降低(风险比0.76;95%置信区间0.62至0.93)。异质性检验表明文章提取具有同质性(I(2)=0%,P=0.67)。为了确定哪种RPM模式最有效,按年龄、疾病严重程度、测量频率、药物管理和干预速度进行了亚组分析。干预迅速的组死亡率最低(迅速组风险比=0.59,非迅速组风险比=0.88,P=0.05)。测量频率高的组死亡率较低(高频组风险比=0.62,低频组风险比=0.89,P=0.07)。有药物管理的组死亡率较低(药物组风险比=0.65,无药物组风险比=0.85,P=0.19)。RPM对慢性心力衰竭有效,迅速干预是RPM模式中最重要的因素。