Efficacy of telemedicine for the management of cardiovascular disease: a systematic review and meta-analysis

Abstract

Background: Telemedicine has been increasingly integrated into chronic disease management through remote patient monitoring and consultation, particularly during the COVID-19 pandemic. We did a systematic review and meta-analysis of studies reporting effectiveness of telemedicine interventions for the management of patients with cardiovascular conditions.

Methods: In this systematic review and meta-analysis, we searched PubMed, Scopus, and Cochrane Library from database inception to Jan 18, 2021. We included randomised controlled trials and observational or cohort studies that evaluated the effects of a telemedicine intervention on cardiovascular outcomes for people either at risk (primary prevention) of cardiovascular disease or with established (secondary prevention) cardiovascular disease, and, for the meta-analysis, we included studies that evaluated the effects of a telemedicine intervention on cardiovascular outcomes and risk factors. We excluded studies if there was no clear telemedicine intervention described or if cardiovascular or risk factor outcomes were not clearly reported in relation to the intervention. Two reviewers independently assessed and extracted data from trials and observational and cohort studies using a standardised template. Our primary outcome was cardiovascular-related mortality. We evaluated study quality using Cochrane risk-of-bias and Newcastle-Ottawa scales. The systematic review and the meta-analysis protocol was registered with PROSPERO (CRD42021221010) and the Malaysian National Medical Research Register (NMRR-20-2471-57236).

Findings: 72 studies, including 127 869 participants, met eligibility criteria, with 34 studies included in meta-analysis (n=13 269 with 6620 [50%] receiving telemedicine). Combined remote monitoring and consultation for patients with heart failure was associated with a reduced risk of cardiovascular-related mortality (risk ratio [RR] 0·83 [95% CI 0·70 to 0·99]; p=0·036) and hospitalisation for a cardiovascular cause (0·71 [0·58 to 0·87]; p=0·0002), mostly in studies with short-term follow-up. There was no effect of telemedicine on all-cause hospitalisation (1·02 [0·94 to 1·10]; p=0·71) or mortality (0·90 [0·77 to 1·06]; p=0·23) in these groups, and no benefits were observed with remote consultation in isolation. Small reductions were observed for systolic blood pressure (mean difference -3·59 [95% CI -5·35 to -1·83] mm Hg; p<0·0001) by remote monitoring and consultation in secondary prevention populations. Small reductions were also observed in body-mass index (mean difference -0·38 [-0·66 to -0·11] kg/m²; p=0·0064) by remote consultation in primary prevention settings.

Interpretation: Telemedicine including both remote disease monitoring and consultation might reduce short-term cardiovascular-related hospitalisation and mortality risk among patients with heart failure. Future research should evaluate the sustained effects of telemedicine interventions.

Funding: The British Heart Foundation.

Figure 1

Study selection

Figure 2

Risk of cardiovascular-related mortality in patients with heart failure studies

Figure 3

Studies reporting risk of cardiovascular-related hospitalisation in patients with heart failure using combined remote monitoring and consultation

Figure 4

Studies reporting risk of all-cause mortality in patients with heart failure during long-term follow-up (A) Remote monitoring and consultation for heart failure management. (B) Remote monitoring only for heart failure management.

Figure 5

Change in blood pressure and body-mass index during short-term follow-up (A) Remote consultation only for secondary cardiovascular disease prevention (systolic blood pressure). (B) Remote monitoring and consultation for secondary cardiovascular disease prevention (systolic blood pressure). (C) Remote monitoring and consultation for secondary cardiovascular disease prevention (diastolic blood pressure). (D) Remote consultation only for primary cardiovascular disease prevention (body-mass index).