Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Centre for Global eHealth Innovation, University Health Network, Toronto, Ontario, Canada.
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Centre for Global eHealth Innovation, University Health Network, Toronto, Ontario, Canada.
Can J Cardiol. 2018 Jul;34(7):897-904. doi: 10.1016/j.cjca.2018.01.022. Epub 2018 Jan 31.
Heart failure represents a significant burden for patients and the Canadian health care system. Home telemonitoring is proposed as an intervention that can improve heart failure outcomes by identifying opportunities for earlier clinical intervention and by providing patients with self-management support between scheduled clinic visits. The objective of this review is to provide clarity with respect to the most recent evidence of the effect of home telemonitoring on heart failure outcomes. Despite some strong evidence that telemonitoring can reduce the risk of mortality and heart failure-related hospitalizations, important inconsistencies exist in the evidence. This article proposes that much of the inconsistency results from differences in the patient population being studied, the type of home telemonitoring intervention, and the implementation setting. Also important is the degree to which intervention fidelity is maintained throughout the course of a study; this is emphasized through a review of the factors that influence the degree to which patients and health care providers use home telemonitoring interventions as intended. In this article we propose that for researchers to produce definitive answers regarding the effect of home telemonitoring on heart failure outcomes, interventions and studies need to be designed and tailored according to the characteristics of the target patient population and the implementation context.
心力衰竭给患者和加拿大医疗保健系统带来了巨大负担。家庭远程监测被提议作为一种干预措施，可以通过识别更早进行临床干预的机会，并在预约就诊期间为患者提供自我管理支持，从而改善心力衰竭的结果。本综述的目的是就家庭远程监测对心力衰竭结果的最新证据提供明确的认识。尽管有一些强有力的证据表明远程监测可以降低死亡率和心力衰竭相关住院的风险，但证据中存在重要的不一致性。本文认为，这种不一致性主要是由于所研究的患者人群、家庭远程监测干预的类型和实施环境的差异所致。同样重要的是，在整个研究过程中保持干预的一致性程度；通过审查影响患者和医疗保健提供者按照预期使用家庭远程监测干预的程度的因素，强调了这一点。在本文中，我们提出，为了让研究人员就家庭远程监测对心力衰竭结果的影响得出明确的答案，干预措施和研究需要根据目标患者人群的特征和实施环境进行设计和定制。
