远程医疗干预在慢性心力衰竭患者治疗中的作用：一项系统评价和荟萃分析。
Role of Telemedicine Intervention in the Treatment of Patients with Chronic Heart Failure: A Systematic Review and Meta-analysis.
作者信息
Wang Chaoqun, Ba Yanqun, Ni Jiajia, Huang Runzhi, Du Xiaofeng
机构信息
Department of Cardiology, The Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
The Sixth Ward, Hangzhou Children's Hospital, Hangzhou, China.
出版信息
Anatol J Cardiol. 2024 Mar 1;28(4):177-86. doi: 10.14744/AnatolJCardiol.2023.3873.
OBJECTIVE
Although telemedicine interventional therapy is an innovative method to reduce public medical burden and improve heart failure, its effectiveness is still controversial. This meta-analysis evaluates the role of telemedicine interventional therapy in the treatment of patients with chronic heart failure.
METHODS
Relevant literature on telemedicine in chronic heart failure treatment was screened and extracted based on predefined criteria. Quality assessment used Cochrane Handbook 5.1.0 tool, and meta-analysis was conducted using R 4.2.2 software.
RESULTS
Fifteen English-language articles were ultimately included in this meta-analysis. The risk bias evaluation determined that 4 articles were low-risk bias and 11 articles were unclear risk bias. The meta-analysis revealed that, compared to the routine intervention group, the all-cause hospitalization rate of patients in the telemedicine intervention group decreased [OR = 0.63, 95% CI (0.41; 0.96), P =.03], and the hospitalization rate of heart failure also decreased [OR = 0.70, 95% CI (0.48; 0.85), P <.01]. However, there were no differences in mortality [OR = 0.64, 95% CI (0.41; 1.01), P =.05], length of hospitalization [MD = -0.42, 95% CI (-1.22; 0.38), P =.31], number of emergency hospitalizations [MD = -0.09, 95% CI (-0.33; 0.15), P =.45], medication compliance [OR = 1.67, 95% CI (0.92; 3.02), P =.09], or MLHFQ scores [MD = -2.30, 95% CI (-6.16; 1.56), P =.24] among the patients.
CONCLUSION
This meta-analysis showed that telemedicine reduced overall and heart failure-related hospitalizations in chronic heart failure patients, suggesting its value in clinical management. However, it did not significantly affect mortality, hospital stay length, emergency visits, medication adherence, or quality of life. This suggests the need to optimize specific aspects of telemedicine, identify key components, and develop strategies for better treatment outcomes.
目的
尽管远程医疗介入治疗是减轻公共医疗负担和改善心力衰竭的一种创新方法，但其有效性仍存在争议。本荟萃分析评估远程医疗介入治疗在慢性心力衰竭患者治疗中的作用。
方法
根据预定义标准筛选并提取有关远程医疗在慢性心力衰竭治疗中的相关文献。质量评估使用Cochrane手册5.1.0工具，并使用R 4.2.2软件进行荟萃分析。
结果
本荟萃分析最终纳入15篇英文文章。风险偏倚评估确定4篇文章为低风险偏倚，11篇文章为风险偏倚不明确。荟萃分析显示，与常规干预组相比，远程医疗干预组患者的全因住院率降低[比值比（OR）=0.63，95%置信区间（CI）（0.41；0.96），P = 0.03]，心力衰竭住院率也降低[OR = 0.70，95% CI（0.48；0.85），P < 0.01]。然而，患者在死亡率[OR = 0.64，95% CI（0.41；1.01），P = 0.05]、住院时间[平均差（MD）=-0.42，95% CI（-1.22；0.38），P = 0.31]、急诊住院次数[MD = -0.09，95% CI（-0.33；0.15），P = 0.45]、药物依从性[OR = 1.67，95% CI（0.92；3.02），P = 0.09]或明尼苏达心力衰竭生活质量问卷（MLHFQ）评分[MD = -2.30，95% CI（-6.16；1.56），P = 0.24]方面没有差异。
结论
本荟萃分析表明，远程医疗降低了慢性心力衰竭患者的总体住院率和与心力衰竭相关的住院率，表明其在临床管理中的价值。然而，它并未显著影响死亡率、住院时间、急诊就诊、药物依从性或生活质量。这表明需要优化远程医疗的具体方面，确定关键组成部分，并制定策略以获得更好的治疗效果。
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