Limits...
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.

Show MeSH

Related in: MedlinePlus

The impact of different forms of telemedicine on the outcome of all-cause mortality.Effect estimates from the network meta-analysis occupy the bottom left part of the diagram, the estimates from the pairwise meta-analyes occupy the top right part of the diagram and the diagonal corresponds to the comparison. The odds ratios and 95% Credible Intervals for the comparisons in this diagram should be read from left to right (e.g. Patients receiving structured telephone support had a 0.80 [0.66, 0.96] reduced odds of death compared to those receiving usual care). Significant results are underlined and in bold.
© Copyright Policy
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4340962&req=5

pone.0118681.g003: The impact of different forms of telemedicine on the outcome of all-cause mortality.Effect estimates from the network meta-analysis occupy the bottom left part of the diagram, the estimates from the pairwise meta-analyes occupy the top right part of the diagram and the diagonal corresponds to the comparison. The odds ratios and 95% Credible Intervals for the comparisons in this diagram should be read from left to right (e.g. Patients receiving structured telephone support had a 0.80 [0.66, 0.96] reduced odds of death compared to those receiving usual care). Significant results are underlined and in bold.

Mentions: Direct comparisons (Fig. 3, S1 and S2 Figs.) show that telemonitoring was found to be more effective than usual care in reducing the numbers of death (Odds ratio (OR) 0.52 95% Confidence Intervals (CI) [0.37, 0.72]), hospitalization (0.70 [0.51, 0.96]), and hospitalization resulting from heart failure (0.70 [0.51, 0.98]). Fewer patients receiving structured telephone support interventions were hospitalized for all causes (0.86 [0.77, 0.97)] and due to heart failure (0.76 [0.65, 0.89)] than patients who received usual care. Similarly, fewer patients who received telemedicine interventions that involved the use of ECG data transmission were hospitalized than patients who received usual care (0.70 [0.55, 0.91]). No other comparisons were found to suggest a significant benefit across the outcomes of death, hospitalization and heart failure related hospitalization for one intervention over the other. For all outcomes, heterogeneity was found to be either low or moderate. Forest plots of each pairwise meta-analysis conducted can be found in Fig. 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)

The impact of different forms of telemedicine on the outcome of all-cause mortality.Effect estimates from the network meta-analysis occupy the bottom left part of the diagram, the estimates from the pairwise meta-analyes occupy the top right part of the diagram and the diagonal corresponds to the comparison. The odds ratios and 95% Credible Intervals for the comparisons in this diagram should be read from left to right (e.g. Patients receiving structured telephone support had a 0.80 [0.66, 0.96] reduced odds of death compared to those receiving usual care). Significant results are underlined and in bold.
© Copyright Policy
Related In: Results  -  Collection

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

pone.0118681.g003: The impact of different forms of telemedicine on the outcome of all-cause mortality.Effect estimates from the network meta-analysis occupy the bottom left part of the diagram, the estimates from the pairwise meta-analyes occupy the top right part of the diagram and the diagonal corresponds to the comparison. The odds ratios and 95% Credible Intervals for the comparisons in this diagram should be read from left to right (e.g. Patients receiving structured telephone support had a 0.80 [0.66, 0.96] reduced odds of death compared to those receiving usual care). Significant results are underlined and in bold.
Mentions: Direct comparisons (Fig. 3, S1 and S2 Figs.) show that telemonitoring was found to be more effective than usual care in reducing the numbers of death (Odds ratio (OR) 0.52 95% Confidence Intervals (CI) [0.37, 0.72]), hospitalization (0.70 [0.51, 0.96]), and hospitalization resulting from heart failure (0.70 [0.51, 0.98]). Fewer patients receiving structured telephone support interventions were hospitalized for all causes (0.86 [0.77, 0.97)] and due to heart failure (0.76 [0.65, 0.89)] than patients who received usual care. Similarly, fewer patients who received telemedicine interventions that involved the use of ECG data transmission were hospitalized than patients who received usual care (0.70 [0.55, 0.91]). No other comparisons were found to suggest a significant benefit across the outcomes of death, hospitalization and heart failure related hospitalization for one intervention over the other. For all outcomes, heterogeneity was found to be either low or moderate. Forest plots of each pairwise meta-analysis conducted can be found in Fig. 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