移动医疗技术干预心力衰竭患者的效果：系统评价和荟萃分析。

Effectiveness of Mobile Health Technology Interventions for Patients With Heart Failure: Systematic Review and Meta-analysis.

机构信息

Department of Biomedical and Health Information Sciences, University of Illinois at Chicago, Chicago, Illinois, USA.

Research Chair in Diginal Health, HEC Montréal, Montréal, Quebec, Canada.

出版信息

Can J Cardiol. 2021 Aug;37(8):1248-1259. doi: 10.1016/j.cjca.2021.02.015. Epub 2021 Mar 3.

DOI:10.1016/j.cjca.2021.02.015

PMID:33667616

Abstract

BACKGROUND

Heart failure (HF) is a complex and serious condition associated with substantial morbidity, mortality, and health care costs. We conducted a systematic review and meta-analysis to evaluate the effects of mobile health (mHealth) interventions compared with usual care in patients with HF.

METHODS

We searched MEDLINE, CENTRAL, CINAHL, and EMBASE databases to identify eligible randomized controlled trials (RCTs) of mHealth interventions. Primary outcomes included: all-cause mortality, cardiovascular mortality, HF-related hospitalizations, and all-cause hospitalizations. Meta-analyses using a random effects model were performed for all outcomes. Risk of bias and quality of evidence were evaluated using the Cochrane Tool and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework.

RESULTS

Sixteen RCTs involving 4389 patients were included. Compared with usual care, mHealth interventions reduced the risk of all-cause mortality (risk ratio [RR], 0.80; 95% confidence interval [CI], 0.65-0.97; absolute risk reduction [ARR], 2.1%; high-quality evidence), cardiovascular mortality (RR, 0.70; 95% CI, 0.53-0.91; ARR, 2.9%; high-quality evidence), and HF hospitalizations (RR, 0.77; 95% CI, 0.67-0.88; ARR, 5%; high-quality evidence), but had no effect on all-cause hospitalizations. Results were driven by mHealth interventions with remote monitoring and clinical feedback, which were associated with larger reductions than stand-alone mHealth interventions. However, subgroup differences were not statistically significant.

CONCLUSIONS

mHealth interventions with remote monitoring and clinical feedback reduce mortality and HF-related hospitalizations, but might not reduce all-cause hospitalizations in patients with HF. Additional studies are needed to determine the efficacy of stand-alone mHealth interventions as well as active features of mHealth that contribute to efficacy.

摘要

背景

心力衰竭（HF）是一种复杂且严重的病症，与大量的发病率、死亡率和医疗保健费用有关。我们进行了系统评价和荟萃分析，以评估移动医疗（mHealth）干预措施与 HF 患者的常规护理相比的效果。

方法

我们搜索了 MEDLINE、CENTRAL、CINAHL 和 EMBASE 数据库，以确定 mHealth 干预措施的合格随机对照试验（RCT）。主要结局包括：全因死亡率、心血管死亡率、HF 相关住院率和全因住院率。使用随机效应模型对所有结局进行荟萃分析。使用 Cochrane 工具和推荐评估、制定与评价（GRADE）框架评估偏倚风险和证据质量。

结果

纳入了 16 项涉及 4389 名患者的 RCT。与常规护理相比，mHealth 干预措施降低了全因死亡率的风险（风险比 [RR]，0.80；95%置信区间 [CI]，0.65-0.97；绝对风险降低 [ARR]，2.1%；高质量证据）、心血管死亡率（RR，0.70；95% CI，0.53-0.91；ARR，2.9%；高质量证据）和 HF 住院率（RR，0.77；95% CI，0.67-0.88；ARR，5%；高质量证据），但对全因住院率没有影响。结果是由具有远程监测和临床反馈的 mHealth 干预措施驱动的，与单独的 mHealth 干预措施相比，这些干预措施与更大的降低相关。然而，亚组差异没有统计学意义。