title: Telehealth interventions for the secondary prevention of coronary heart disease: a systematic review.
abstract: Coronary heart disease (CHD) is a leading cause of death globally. Despite proven health benefits and international recommendations, attendance at cardiac rehabilitation programs is poor. Telehealth (phone, Internet, and videoconference communication between patient and health-care provider) has emerged as an innovative way of delivering health interventions. This review aimed to determine telehealth effectiveness in CHD management. Study design includes systematic review with meta-analysis. Randomized controlled trials evaluating telehealth interventions in patients with CHD were identified by searching multiple electronic databases, reference lists, relevant conference lists, gray literature, and key-word searching of the Internet. Studies were selected if they evaluated a telephone, videoconference, or web-based intervention, provided objective measurements of mortality, changes in multiple risk factor levels or quality of life. In total, 11 trials were identified (3145 patients). Telehealth interventions were associated with nonsignificant lower all-cause mortality than controls [relative risk=0.70, 95% confidence interval (CI)=0.45-1.1; P=0.12]. These interventions showed a significantly lower weighted mean difference (WMD) at medium long-term follow-up than controls for total cholesterol (WMD=0.37 mmol/l, 95% CI=0.19-0.56, P<0.001), systolic blood pressure (WMD=4.69 mmHg, 95% CI=2.91-6.47, P<0.001), and fewer smokers (relative risk = 0.84, 95% CI=0.65-0.98, P = 0.04). Significant favorable changes at follow-up were also found in high-density lipoprotien and low-density lipoprotein. In conclusion, telehealth interventions provide effective risk factor reduction and secondary prevention. Provision of telehealth models could help increase uptake of a formal secondary prevention by those who do not access cardiac rehabilitation and narrow the current evidence-practice gap.
authors.affiliation: Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia. lneubeck@med.usyd.edu.au
authors.forename: Lis
authors.initials: L
authors.lastname: Neubeck
authors.forename: Julie
authors.initials: J
authors.lastname: Redfern
authors.forename: Ritin
authors.initials: R
authors.lastname: Fernandez
authors.forename: Tom
authors.initials: T
authors.lastname: Briffa
authors.forename: Adrian
authors.initials: A
authors.lastname: Bauman
authors.forename: Saul Ben
authors.initials: SB
authors.lastname: Freedman
mesh_terms: D003327:Coronary Disease / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D019317:Evidence-Based Medicine; D006801:Humans; D020407:Internet; D016017:Odds Ratio; D010043:Outcome and Process Assessment, Health Care; D010342:Patient Acceptance of Health Care; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012307:Risk Factors; D055502:Secondary Prevention / Q000379:methods*; D017216:Telemedicine; D013689:Telephone; D013997:Time Factors; D016896:Treatment Outcome; D049269:Videoconferencing