Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
J Med Internet Res. 2023 Sep 26;25:e47947. doi: 10.2196/47947.
Mitral regurgitation (MR) and tricuspid regurgitation (TR) are common cardiac conditions with high mortality risks, which can be improved through early intervention. Telehealth services, which allow for remote monitoring of patient conditions, have been proven to improve the health management of chronic diseases, but the effects on MR and TR progression are unknown.
This study aimed to explore whether patients receiving telehealth services have less MR and TR progression compared with a control group. We also aimed to identify the determinants of MR and TR progression.
This single-center retrospective study conducted at the National Taiwan University Hospital compared MR and TR progression (defined as either progression to moderate or greater MR and TR or MR and TR progression by ≥2 grades during the study period) between the telehealth and control groups. Patients had a minimum of 2 transthoracic echocardiograms at least 6 months apart; baseline mild-moderate MR and TR or lower; and no prior surgeries on the mitral or tricuspid valve. Telehealth patients were defined as those who received telehealth services for at least 28 days within 3 months of baseline. Basic demographics, baseline blood pressure measurements, prescribed medication, and Charlson Comorbidity Index components were obtained for all patients.
A total of 1081 patients (n=226 in the telehealth group and n=855 in the control group) were included in the study analyses. The telehealth group showed significantly lower baseline systolic blood pressure (P<.001), higher Charlson Comorbidity Index (P=.02), higher prevalence of prior myocardial infarction (P=.01) and heart failure (P<.001), higher beta-blocker (P=.03) and diuretic (P=.04) use, and lower nitrate use (P=.04). Both groups showed similar cardiac remodeling conditions at baseline. Telehealth was found to be neutral for both MR (hazard ratio 1.10, 95% CI 0.80-1.52; P=.52) and TR (hazard ratio 1.27, 95% CI 0.92-1.74; P=.14) progression. Determinants for moderate or greater MR progression included older age, female sex, diuretic use, larger left atrial dimension, left ventricular end-diastolic dimension, left ventricular end-systolic dimension, and lower left ventricular ejection fraction. Determinants of moderate or greater TR progression included older age, female sex, diuretic use, presence of atrial fibrillation, LA dimension, left ventricular end-systolic dimension, and lower left ventricular ejection fraction; statin use was found to be protective.
This is the first study to assess the association between telehealth services and the progression of MR and TR. Telehealth patients, who had more comorbidities, displayed similar MR and TR progression versus control patients, indicating that telehealth may slow MR and TR progression. Determinants of MR and TR progression included easy-to-measure traditional echo parameters of cardiac function, older age, female sex, and atrial fibrillation, which can be incorporated into a telehealth platform and advanced alert system, improving patient outcomes through personalized care.
二尖瓣反流（MR）和三尖瓣反流（TR）是常见的心脏疾病，具有较高的死亡率风险，早期干预可改善其预后。远程医疗服务可以对患者病情进行远程监测，已被证明可改善慢性病的健康管理，但对于 MR 和 TR 进展的影响尚不清楚。
本研究旨在探讨接受远程医疗服务的患者与对照组相比，MR 和 TR 进展是否更少。我们还旨在确定 MR 和 TR 进展的决定因素。
这项在国立台湾大学医院进行的单中心回顾性研究比较了远程医疗组和对照组之间的 MR 和 TR 进展（定义为研究期间进展为中度或更严重的 MR 和 TR 或 MR 和 TR 进展≥2 级）。患者至少有 2 次至少间隔 6 个月的经胸超声心动图检查；基线轻度至中度 MR 和 TR 或更低；且二尖瓣或三尖瓣无既往手术史。远程医疗患者被定义为在基线后 3 个月内至少接受了 28 天远程医疗服务的患者。所有患者均获得了基本人口统计学资料、基线血压测量值、处方药物和 Charlson 合并症指数成分。
共纳入 1081 例患者（远程医疗组 226 例，对照组 855 例）进行研究分析。远程医疗组的基线收缩压明显较低（P<.001），Charlson 合并症指数较高（P=.02），既往心肌梗死（P=.01）和心力衰竭（P<.001）的患病率较高，β受体阻滞剂（P=.03）和利尿剂（P=.04）的使用率较高，硝酸盐的使用率较低（P=.04）。两组患者的基线心脏重构情况相似。远程医疗对 MR（风险比 1.10，95%置信区间 0.80-1.52；P=.52）和 TR（风险比 1.27，95%置信区间 0.92-1.74；P=.14）进展均无影响。中度或更严重的 MR 进展的决定因素包括年龄较大、女性、利尿剂使用、左心房内径较大、左心室舒张末期内径、左心室收缩末期内径和左心室射血分数较低。中度或更严重的 TR 进展的决定因素包括年龄较大、女性、利尿剂使用、心房颤动、左心房内径、左心室收缩末期内径和左心室射血分数较低；他汀类药物的使用被认为具有保护作用。
这是第一项评估远程医疗服务与 MR 和 TR 进展之间关联的研究。远程医疗组患者合并症更多，与对照组患者相比，MR 和 TR 进展情况相似，表明远程医疗可能会减缓 MR 和 TR 的进展。MR 和 TR 进展的决定因素包括心脏功能的易于测量的传统超声心动图参数、年龄较大、女性和心房颤动，这些因素可以纳入远程医疗平台和高级预警系统，通过个性化护理改善患者预后。
