Research Center of Intelligent Equipment and Technology, Yangtze Delta Region Institute of Tsinghua University, Jiaxing, China.
Department of Respiratory, Affiliated Hospital of Jiaxing University, Jiaxing, China.
Ann Palliat Med. 2021 Dec;10(12):12831-12844. doi: 10.21037/apm-21-3626.
With the development of information communication technology (ICT), telemedicine has become a promising option for patients with chronic diseases who need continuous monitoring at home or in remote health care facilities. As cardiovascular disease (CVD) is responsible for an estimated 17.9 million deaths globally each year, it is appropriate to evaluate the effectiveness of telemedicine for the health care management of CVD patients.
The Library of Congress, LISTA (EBSCO), PubMed (NLM), and Web of Science databases were searched with a date limitation from 1 January 2000 until 5 August 2021 for Randomized Controlled Trial (RCT) studies. Two independent researchers screened the records for inclusion and extracted the data for synthesis, supported by RevMan 5.0 software. As one of the clinical outcomes, the mean difference and standard deviation of systolic blood pressure were synthesized. For the Quality-of-life measures, EuroQol-5D (EQ-5D) scores were also synthesized and for the depression level, CESD-10 scores were synthesized.
We identified 23 studies for qualitative analysis and 21 studies for quantitative analysis. 21 studies included systolic blood pressure as an outcome measure and the results show a statistical difference (P<0.05) between the intervention group and the control group and a favorable inclination toward the Telemedicine enhanced health care program over the usual care. Of the six studies that included body mass index (BMI) as an outcome measure, there was no significant difference in BMI between the telemedicine and usual health care groups. A total of five studies assessed patients' quality of life using the EQ-5D instrument. After excluding one study following the sensitivity analysis, telemedicine was shown to significantly improve patients' quality of life. Three studies that investigated patients' mental health (CSE-D-10) also showed a significantly beneficial effect of telemedicine over usual health care.
This review found limited evidence to support some of the outcomes in the original study designs. Overall, our findings suggested a favorable effect of telemedicine intervention in the field of health care for CVD patients. Due to the unavoidable heterogeneity within the selected literature, a more detailed investigation and analysis of the unclear outcomes is recommended.
随着信息通信技术（ICT）的发展，远程医疗已成为需要在家或远程医疗设施中进行持续监测的慢性病患者的一种有前途的选择。由于心血管疾病（CVD）每年在全球造成约 1790 万人死亡，因此评估远程医疗在 CVD 患者的医疗保健管理中的有效性是合适的。
从 2000 年 1 月 1 日至 2021 年 8 月 5 日，使用图书馆资源（国会图书馆、LISTA（EBSCO）、PubMed（NLM）和 Web of Science 数据库）对随机对照试验（RCT）研究进行了搜索。两名独立的研究人员对记录进行筛选以进行纳入，并使用 RevMan 5.0 软件支持的数据进行综合。作为临床结果之一，综合了收缩压的平均值差异和标准差。对于生活质量措施，还综合了 EuroQol-5D（EQ-5D）评分，对于抑郁水平，综合了 CESD-10 评分。
我们确定了 23 项研究进行定性分析，21 项研究进行定量分析。21 项研究包括收缩压作为观察指标，结果表明干预组与对照组之间存在统计学差异（P<0.05），并且倾向于远程医疗增强医疗保健计划优于常规医疗保健。在包括体重指数（BMI）作为观察指标的六项研究中，远程医疗组和常规医疗保健组之间的 BMI 没有显著差异。共有五项研究使用 EQ-5D 工具评估患者的生活质量。在进行敏感性分析排除一项研究后，远程医疗显著改善了患者的生活质量。三项研究调查了患者的心理健康（CSE-D-10），也表明远程医疗对常规医疗保健有明显的有益作用。
本综述发现，有限的证据支持原始研究设计中的一些结果。总体而言，我们的研究结果表明远程医疗干预在 CVD 患者的医疗保健领域具有有利影响。由于所选文献中不可避免的异质性，建议对不清楚的结果进行更详细的调查和分析。
