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Comparative effectiveness of different forms of telemedicine for individuals with heart failure (HF): a systematic review and network meta-analysis.

Kotb A, Cameron C, Hsieh S, Wells G - PLoS ONE (2015)

Bottom Line: Previous studies on telemedicine have either focused on its role in the management of chronic diseases in general or examined its effectiveness in comparison to standard post-discharge care.This has therefore limited our current understanding of how some of the less common forms of telemedicine compare to one another.Further research into their comparative cost-effectiveness is also warranted.

View Article: PubMed Central - PubMed

Affiliation: University of Ottawa Heart Institute, Ottawa, Canada.

ABSTRACT

Background: Previous studies on telemedicine have either focused on its role in the management of chronic diseases in general or examined its effectiveness in comparison to standard post-discharge care. Little has been done to determine the comparative impact of different telemedicine options for a specific population such as individuals with heart failure (HF).

Methods and findings: Systematic reviews (SR) of randomized controlled trials (RCTs) that examined telephone support, telemonitoring, video monitoring or electrocardiographic monitoring for HF patients were identified using a comprehensive search of the following databases: MEDLINE, EMBASE, CINAHL and The Cochrane Library. Studies were included if they reported the primary outcome of mortality or any of the following secondary outcomes: all-cause hospitalization and heart failure hospitalization. Thirty RCTs (N = 10,193 patients) were included. Compared to usual care, structured telephone support was found to reduce the odds of mortality(Odds Ratio 0.80; 95% Credible Intervals [0.66 to 0.96]) and hospitalizations due to heart failure (0.69; [0.56 to 0.85]). Telemonitoring was also found to reduce the odds of mortality(0.53; [0.36 to 0.80]) and reduce hospitalizations related to heart failure (0.64; [0.39 to 0.95]) compared to usual post-discharge care. Interventions that involved ECG monitoring also reduced the odds of hospitalization due to heart failure (0.71; [0.52 to 0.98]).

Limitations: Much of the evidence currently available has focused on the comparing either telephone support or telemonitoring with usual care. This has therefore limited our current understanding of how some of the less common forms of telemedicine compare to one another.

Conclusions: Compared to usual care, structured telephone support and telemonitoring significantly reduced the odds of deaths and hospitalization due to heart failure. Despite being the most widely studied forms of telemedicine, little has been done to directly compare these two interventions against one another. Further research into their comparative cost-effectiveness is also warranted.

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Related in: MedlinePlus

Flow chart for the identification of studies used in the network meta-analysis of telemedicine interventions for heart failure patients
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pone.0118681.g001: Flow chart for the identification of studies used in the network meta-analysis of telemedicine interventions for heart failure patients

Mentions: Of the 757 citations identified from our literature search, 700 were excluded after examining their titles and abstracts. The full manuscripts of the remaining 57 were assessed. From those, we identified 8 eligible systematic reviews [1,3,4,18–28]. Fig. 1 shows a modified PRISMA diagram describing the selection of studies. Of the included reviews, 5 included a meta-analysis of the data. Six out of the 8 reviews were found to have met the following criteria: duplicate study selection and data extraction; comprehensive literature search; provided characteristics of their included studies; and assessed their included studies’ scientific quality. Characteristics of these reviews and their AMSTAR quality assessment are detailed in Tables B and C in S1 File.


Comparative effectiveness of different forms of telemedicine for individuals with heart failure (HF): a systematic review and network meta-analysis.

Kotb A, Cameron C, Hsieh S, Wells G - PLoS ONE (2015)

Flow chart for the identification of studies used in the network meta-analysis of telemedicine interventions for heart failure patients
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4340962&req=5

pone.0118681.g001: Flow chart for the identification of studies used in the network meta-analysis of telemedicine interventions for heart failure patients
Mentions: Of the 757 citations identified from our literature search, 700 were excluded after examining their titles and abstracts. The full manuscripts of the remaining 57 were assessed. From those, we identified 8 eligible systematic reviews [1,3,4,18–28]. Fig. 1 shows a modified PRISMA diagram describing the selection of studies. Of the included reviews, 5 included a meta-analysis of the data. Six out of the 8 reviews were found to have met the following criteria: duplicate study selection and data extraction; comprehensive literature search; provided characteristics of their included studies; and assessed their included studies’ scientific quality. Characteristics of these reviews and their AMSTAR quality assessment are detailed in Tables B and C in S1 File.

Bottom Line: Previous studies on telemedicine have either focused on its role in the management of chronic diseases in general or examined its effectiveness in comparison to standard post-discharge care.This has therefore limited our current understanding of how some of the less common forms of telemedicine compare to one another.Further research into their comparative cost-effectiveness is also warranted.

View Article: PubMed Central - PubMed

Affiliation: University of Ottawa Heart Institute, Ottawa, Canada.

ABSTRACT

Background: Previous studies on telemedicine have either focused on its role in the management of chronic diseases in general or examined its effectiveness in comparison to standard post-discharge care. Little has been done to determine the comparative impact of different telemedicine options for a specific population such as individuals with heart failure (HF).

Methods and findings: Systematic reviews (SR) of randomized controlled trials (RCTs) that examined telephone support, telemonitoring, video monitoring or electrocardiographic monitoring for HF patients were identified using a comprehensive search of the following databases: MEDLINE, EMBASE, CINAHL and The Cochrane Library. Studies were included if they reported the primary outcome of mortality or any of the following secondary outcomes: all-cause hospitalization and heart failure hospitalization. Thirty RCTs (N = 10,193 patients) were included. Compared to usual care, structured telephone support was found to reduce the odds of mortality(Odds Ratio 0.80; 95% Credible Intervals [0.66 to 0.96]) and hospitalizations due to heart failure (0.69; [0.56 to 0.85]). Telemonitoring was also found to reduce the odds of mortality(0.53; [0.36 to 0.80]) and reduce hospitalizations related to heart failure (0.64; [0.39 to 0.95]) compared to usual post-discharge care. Interventions that involved ECG monitoring also reduced the odds of hospitalization due to heart failure (0.71; [0.52 to 0.98]).

Limitations: Much of the evidence currently available has focused on the comparing either telephone support or telemonitoring with usual care. This has therefore limited our current understanding of how some of the less common forms of telemedicine compare to one another.

Conclusions: Compared to usual care, structured telephone support and telemonitoring significantly reduced the odds of deaths and hospitalization due to heart failure. Despite being the most widely studied forms of telemedicine, little has been done to directly compare these two interventions against one another. Further research into their comparative cost-effectiveness is also warranted.

Show MeSH
Related in: MedlinePlus