智能手机在心血管疾病二级预防中的应用：一项系统综述。
Smartphones in the secondary prevention of cardiovascular disease: a systematic review.
作者信息
Hamilton Sandra J, Mills Belynda, Birch Eleanor M, Thompson Sandra C
机构信息
Western Australian Centre for Rural Health, University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia.
Georgetown University, 3700 O St NW, Washington, DC, 20057, USA.
出版信息
BMC Cardiovasc Disord. 2018 Feb 7;18(1):25. doi: 10.1186/s12872-018-0764-x.
BACKGROUND
Cardiac Rehabilitation (CR) and secondary prevention are effective components of evidence-based management for cardiac patients, resulting in improved clinical and behavioural outcomes. Mobile health (mHealth) is a rapidly growing health delivery method that has the potential to enhance CR and heart failure management. We undertook a systematic review to assess the evidence around mHealth interventions for CR and heart failure management for service and patient outcomes, cost effectiveness with a view to how mHealth could be utilized for rural, remote and Indigenous cardiac patients.
METHODS
A comprehensive search of databases using key terms was conducted for the years 2000 to August 2016 to identify randomised and non-randomised trials utilizing smartphone functionality and a model of care that included CR and heart failure management. Included studies were assessed for quality and risk of bias and data extraction was undertaken by two independent reviewers.
RESULTS
Nine studies described a mix of mHealth interventions for CR (5 studies) and heart failure (4 studies) in the following categories: feasibility, utility and uptake studies; and randomised controlled trials. Studies showed that mHealth delivery for CR and heart failure management is feasible with high rates of participant engagement, acceptance, usage, and adherence. Moreover, mHealth delivery of CR was as effective as traditional centre-based CR (TCR) with significant improvement in quality of life. Hospital utilization for heart failure patients showed inconsistent reductions. There was limited inclusion of rural participants.
CONCLUSION
Mobile health delivery has the potential to improve access to CR and heart failure management for patients unable to attend TCR programs. Feasibility testing of culturally appropriate mHealth delivery for CR and heart failure management is required in rural and remote settings with subsequent implementation and evaluation into local health care services.
背景
心脏康复（CR）和二级预防是心脏病患者循证管理的有效组成部分，可改善临床和行为结局。移动健康（mHealth）是一种快速发展的医疗服务提供方式，有潜力加强心脏康复和心力衰竭管理。我们进行了一项系统评价，以评估围绕mHealth干预措施用于心脏康复和心力衰竭管理对服务及患者结局、成本效益的证据，旨在了解如何将mHealth用于农村、偏远地区和原住民心脏病患者。
方法
对2000年至2016年8月的数据库进行全面检索，使用关键词识别利用智能手机功能以及包含心脏康复和心力衰竭管理的护理模式的随机和非随机试验。对纳入研究进行质量和偏倚风险评估，由两名独立 reviewers 进行数据提取。
结果
九项研究描述了以下几类针对心脏康复（5项研究）和心力衰竭（4项研究）的多种mHealth干预措施：可行性、实用性和接受度研究；以及随机对照试验。研究表明，通过mHealth进行心脏康复和心力衰竭管理是可行的，参与者的参与度、接受度、使用率和依从率都很高。此外，mHealth提供的心脏康复与传统的基于中心的心脏康复（TCR）一样有效，生活质量有显著改善。心力衰竭患者的医院利用率显示出不一致的下降。农村参与者的纳入有限。
结论
移动健康服务有潜力改善无法参加TCR项目的患者获得心脏康复和心力衰竭管理的机会。需要在农村和偏远地区对适合文化背景的mHealth用于心脏康复和心力衰竭管理进行可行性测试，随后在当地医疗服务中实施和评估。
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