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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

Evidence network for interventions included in the analysis of all-cause mortality.Each node represents an intervention and the size of each node indicates how many patients received it of the total number of patients included in the network (N = 10,193). The solid lines connecting the nodes together indicate the existence of this comparison of interventions in the literature. The thickness of the lines represents how many studies of the total number of studies (30 studies) include a particular comparison.
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pone.0118681.g002: Evidence network for interventions included in the analysis of all-cause mortality.Each node represents an intervention and the size of each node indicates how many patients received it of the total number of patients included in the network (N = 10,193). The solid lines connecting the nodes together indicate the existence of this comparison of interventions in the literature. The thickness of the lines represents how many studies of the total number of studies (30 studies) include a particular comparison.

Mentions: Twenty-nine trials contributed to the analysis of the outcome of death, twenty to the analysis of hospitalization and sixteen for the analysis of hospitalization due to heart failure. Of the 15 possible pairwise comparisons that can be made across the 6 interventions, the evidence available was found to have only examined 8 comparisons directly for death as well as for hospitalization. Six out of 10 possible pairwise comparisons were available for hospitalization due to heart failure. Fig. 2 shows the evidence network for the outcome of death. For the outcomes of hospitalization and heart failure hospitalization, the evidence networks are provided in Figs. A and B 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)

Evidence network for interventions included in the analysis of all-cause mortality.Each node represents an intervention and the size of each node indicates how many patients received it of the total number of patients included in the network (N = 10,193). The solid lines connecting the nodes together indicate the existence of this comparison of interventions in the literature. The thickness of the lines represents how many studies of the total number of studies (30 studies) include a particular comparison.
© Copyright Policy
Related In: Results  -  Collection

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

pone.0118681.g002: Evidence network for interventions included in the analysis of all-cause mortality.Each node represents an intervention and the size of each node indicates how many patients received it of the total number of patients included in the network (N = 10,193). The solid lines connecting the nodes together indicate the existence of this comparison of interventions in the literature. The thickness of the lines represents how many studies of the total number of studies (30 studies) include a particular comparison.
Mentions: Twenty-nine trials contributed to the analysis of the outcome of death, twenty to the analysis of hospitalization and sixteen for the analysis of hospitalization due to heart failure. Of the 15 possible pairwise comparisons that can be made across the 6 interventions, the evidence available was found to have only examined 8 comparisons directly for death as well as for hospitalization. Six out of 10 possible pairwise comparisons were available for hospitalization due to heart failure. Fig. 2 shows the evidence network for the outcome of death. For the outcomes of hospitalization and heart failure hospitalization, the evidence networks are provided in Figs. A and B 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