Gu Xiang, Zhu Ye, Zhang Yi, Sun Lei, Bao Zheng-Yu, Shen Jian-Hua, Chen Fu-Kun, Li Hong-Xiao, Miao Shu-Hang, Wang Jing-Wu, Shi Qing-Qing
Clinical Medical College, Yangzhou University, Yangzhou, Jiangsu, China.
Department of Cardiology, Subei People's Hospital, Yangzhou, Jiangsu, China.
J Geriatr Cardiol. 2017 Aug;14(8):501-508. doi: 10.11909/j.issn.1671-5411.2017.08.013.
Telehealth interventions (THI) were associated with lower levels of cardiovascular risk factors in adults, whereas the effect of THI on cardiovascular disease (CVD) still remains controversial. A meta-analysis was conducted to summarize the evidence from randomized controlled trials (RCT) which investigated potential impact of THI on the incidence of CVD in patients with or without prior CVD.
PubMed, EmBase, and the Cochrane Library were searched to identify RCTs to fit our analysis through December 2016. Relative risk (RR) with its 95% confidence interval (CI) was used to measure the effect of THI using a random-effect model. Sensitivity analysis, subgroup analysis, heterogeneity tests, and tests for publication bias were also conducted.
Eight RCTs were included and with a total of 1635 individuals. The summarized results indicated that participants who received THI showed a significant reduction of the CVD incidence as compared with usual care (RR: 0.59; 95% CI: 0.47-0.74; < 0.001). Furthermore, the effect of THI was greater in patients with history of CVD (RR: 0.55; 95% CI: 0.44-0.70; < 0.001) than in patients without history of CVD (RR: 0.99; 95% CI: 0.51-1.94; = 0.977). Sensitivity analysis suggested that the intervention effect persisted and the conclusion was not changed. Subgroup analysis indicated mean age, study quality might play an important role on the risk of CVD.
The findings of this study indicated THI could reduce the recurrence of CVD. Further large-scale trials are needed to verify the effect of THI on CVD in healthy individuals.
远程医疗干预（THI）与成年人较低水平的心血管危险因素相关，而THI对心血管疾病（CVD）的影响仍存在争议。进行了一项荟萃分析，以总结来自随机对照试验（RCT）的证据，这些试验调查了THI对有或无既往CVD患者CVD发病率的潜在影响。
检索PubMed、EmBase和Cochrane图书馆，以确定截至2016年12月适合我们分析的RCT。使用随机效应模型，用相对风险（RR）及其95%置信区间（CI）来衡量THI的效果。还进行了敏感性分析、亚组分析、异质性检验和发表偏倚检验。
纳入了8项RCT，共1635名个体。汇总结果表明，与常规护理相比，接受THI的参与者CVD发病率显著降低（RR：0.59；95%CI：0.47 - 0.74；P < 0.001）。此外，THI对有CVD病史的患者（RR：0.55；95%CI：0.44 - 0.70；P < 0.001）的影响大于无CVD病史的患者（RR：0.99；95%CI：0.51 - 1.94；P = 0.977）。敏感性分析表明干预效果持续存在，结论未改变。亚组分析表明平均年龄、研究质量可能对CVD风险起重要作用。
本研究结果表明THI可降低CVD的复发率。需要进一步的大规模试验来验证THI对健康个体CVD的影响。
