1 Department of Neurology, University Hospital Würzburg, Würzburg, Germany.
2 Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany.
Int J Stroke. 2017 Aug;12(6):597-605. doi: 10.1177/1747493017706188. Epub 2017 Apr 25.
Background Data from European countries consistently show that guideline-conform secondary prevention after stroke/transient ischemic attack is being realized in only 50-80% of patients. Use of telemedicine to support long-term secondary prevention has been effective in other cardiovascular diseases. Aims We reviewed current evidence for telemedical-supported strategies for the improvement of secondary prevention after stroke/transient ischemic attack. A systematic review was performed in accordance with the PRISMA statement searching MEDLINE, the Cochrane Central Register of Controlled Trials, and reference lists of articles published until 18 May 2016. Randomized controlled trials and observational studies were included if they analyzed the effect of a telemedical strategy for supporting secondary prevention after stroke/transient ischemic attack compared to usual care and reported primary (behavior according to guidelines, e.g., medication adherence) or surrogate outcomes (consequences of primary outcome, e.g., blood pressure). Summary of review The review included 13 of 100 identified studies involving 2672 patients. Telemedical support mainly comprised telephone interventions, predominantly done by nurses. Outcomes were heterogeneous: medication adherence did not differ in one randomized controlled trial (p = 0.089). Mortality was reported in one study and was significantly (p < 0.001) higher in patients non-participating in a web-based intervention. Four studies assessed blood pressure in a comparable way that allowed calculation of a meta-analysis. In that, telemedical intervention had a significant blood-pressure lowering effect compared to the control group (mean difference -6.14 (95% confidence interval -10.41, -1.87), p = 0.005). Conclusions Telemedical-supported secondary prevention in cerebrovascular diseases might be effective but larger trials with standardized interventions and outcome measures including clinical endpoints are needed.
来自欧洲国家的数据显示，仅有 50-80%的中风/短暂性脑缺血发作患者遵循指南进行二级预防。在其他心血管疾病中，使用远程医疗来支持长期二级预防已被证明是有效的。目的：我们回顾了目前关于使用远程医疗支持策略改善中风/短暂性脑缺血发作后二级预防的证据。我们按照 PRISMA 声明进行了系统评价，检索了 MEDLINE、Cochrane 对照试验中心注册库和截至 2016 年 5 月 18 日发表的文章的参考文献列表。如果分析了远程医疗策略对中风/短暂性脑缺血发作后二级预防的支持作用，并与常规护理进行比较，且报告了初级（根据指南的行为，如药物依从性）或替代结局（初级结局的后果，如血压），则纳入随机对照试验和观察性研究。综述总结：该综述纳入了 100 项研究中的 13 项，共涉及 2672 名患者。远程医疗支持主要包括电话干预，主要由护士进行。结局指标各不相同：一项随机对照试验中（p = 0.089）药物依从性无差异。一项研究报告了死亡率，且未参与基于网络的干预的患者死亡率显著更高（p < 0.001）。四项研究以可进行荟萃分析的方式评估了血压，结果表明远程医疗干预与对照组相比具有显著的降压效果（平均差异-6.14（95%置信区间-10.41，-1.87），p = 0.005）。结论：远程医疗支持的脑血管疾病二级预防可能有效，但需要更大规模的试验，使用标准化干预措施和包括临床终点在内的结局测量。
