Social Involvement of Critical and Emergency Medicine, CTS-609 Research Group, Poniente Hospital, 04700 El Ejido-Almería, Spain.
Nursing Department, University of Murcia, 30120 Murcia, Spain.
Int J Environ Res Public Health. 2021 Nov 18;18(22):12120. doi: 10.3390/ijerph182212120.
(1) Introduction: In the last two decades, telemedicine has been increasingly applied to telemonitoring (TM) of patients with pacemakers; however, presently, its growth has significantly accelerated because of the COVID-19 pandemic, which has pushed patients and healthcare workers alike to seek new ways to stay healthy with minimal physical contact. Therefore, the main objective of this study was to update the current knowledge on the differences in the medium-and long-term effectiveness of TM and conventional monitoring (CM) in relation to costs and health outcomes. (2) Methods: Three databases and one scientific registry were searched (PubMed, EMBASE, Scopus, and Google Scholar), with no restrictions on language or year of publication. Studies published until July 2021 were included. The inclusion criteria were: (a) experimental or observational design, (b) complete economic evaluation, (c) patients with implanted pacemakers, and (d) comparison of TM with CM. Measurements of study characteristics (author, study duration, sample size, age, sex, major indication for implantation, and pacemaker used), analysis, significant results of the variables (analysis performed, primary endpoints, secondary endpoints, health outcomes, and cost outcomes), and further miscellaneous measurements (methodological quality, variables coded, instrument development, coder training, and intercoder reliability, etc.) were included. (3) Results: 11 studies met the inclusion criteria, consisting of 3372 enrolled patients; 1773 (52.58%) of them were part of randomized clinical trials. The mean age was 72 years, and the atrioventricular block was established as the main indication for device implantation. TM was significantly effective in detecting the presence or absence of pacemaker problems, leading to a reduction in the number of unscheduled hospital visits (8.34-55.55%). The cost of TM was up to 87% lower than that of CM. There were no significant differences in health-related quality of life (HRQoL) and the number of cardiovascular events. (4) Conclusions: Most of the studies included in this systematic review confirm that in the TM group of patients with pacemakers, cardiovascular events are detected and treated earlier, and the number of unscheduled visits to the hospital is significantly reduced, without affecting the HRQoL of patients. In addition, with TM modality, both formal and informal costs are significantly reduced in the medium and long term.
（1）引言：在过去的二十年中，远程医疗已越来越多地应用于起搏器患者的远程监测（TM）；然而，由于 COVID-19 大流行，目前它的发展已经大大加速，这迫使患者和医护人员都寻求新的方法，以在保持身体最小接触的情况下保持健康。因此，本研究的主要目的是更新关于 TM 与传统监测（CM）在成本和健康结果方面的中长期有效性差异的现有知识。（2）方法：在三个数据库和一个科学注册处进行了搜索（PubMed、EMBASE、Scopus 和 Google Scholar），没有对语言或出版年份进行限制。纳入截至 2021 年 7 月发表的研究。纳入标准为：（a）实验或观察性设计，（b）完整的经济评估，（c）植入起搏器的患者，以及（d）TM 与 CM 的比较。测量研究特征（作者、研究持续时间、样本量、年龄、性别、主要植入适应证和使用的起搏器）、分析、变量的显著结果（进行的分析、主要终点、次要终点、健康结果和成本结果）以及其他杂项测量（方法学质量、编码变量、仪器开发、编码员培训和编码员间可靠性等）。（3）结果：符合纳入标准的研究有 11 项，共纳入 3372 名患者；其中 1773 名（52.58%）患者为随机临床试验的一部分。平均年龄为 72 岁，房室传导阻滞被确立为设备植入的主要适应证。TM 在检测起搏器是否存在问题方面非常有效，可减少非计划性就诊次数（8.34-55.55%）。TM 的成本最高可降低 87%，比 CM 低。健康相关生活质量（HRQoL）和心血管事件数量无显著差异。（4）结论：本系统评价纳入的大多数研究证实，在起搏器患者的 TM 组中，心血管事件更早被发现和治疗，非计划性就诊次数显著减少，而不会影响患者的 HRQoL。此外，在 TM 模式下，长期来看正式和非正式成本都显著降低。
