title: Telehealth interventions for primary prevention of cardiovascular disease: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To assess the effectiveness of telehealth interventions in the primary prevention of cardiovascular disease in adult patients in community settings.
  
  
  METHODS
  Systematic literature review of randomised controlled trials comparing the effectiveness of telehealth interventions to reduce overall cardiovascular disease (CVD) risk and/or to reduce multiple CVD risk factors compared with a non-telehealth control group was conducted in June 2013. Study quality was assessed using the Cochrane Risk of Bias tool. Fixed and random effects models were combined with a narrative synthesis for meta-analysis of included studies.
  
  
  RESULTS
  Three of 13 included studies measured Framingham 10-year CVD risk scores, and meta-analysis showed no clear evidence of reduction in overall risk (SMD -0.37%, 95% CI -2.08, 1.33). There was weak evidence for a reduction in systolic blood pressure (SMD -1.22 mmHg 95% CI -2.80, 0.35) and total cholesterol (SMD -0.07 mmol/L 95% CI -0.19, 0.06). There was no change in High-Density Lipoprotein cholesterol or smoking rates.
  
  
  CONCLUSIONS
  There is insufficient evidence to determine the effectiveness of telehealth interventions in reducing overall CVD risk. More studies are needed that consistently measure overall CVD risk, directly compare different telehealth interventions, and determine cost effectiveness of telehealth interventions for prevention of CVD.
authors.affiliation: Centre for Academic Primary Care, School of Social & Community Medicine, University of Bristol, 39 Whatley Road, Clifton BS8 2PS, UK. Electronic address: sam@merriel.com.au.
authors.forename: Samuel William David
authors.initials: SW
authors.lastname: Merriel
authors.affiliation: Centre for Academic Primary Care, School of Social & Community Medicine, University of Bristol, 39 Whatley Road, Clifton BS8 2PS, UK. Electronic address: Verity.andrews@bristol.ac.uk.
authors.forename: Verity
authors.initials: V
authors.lastname: Andrews
authors.affiliation: Centre for Academic Primary Care, School of Social & Community Medicine, University of Bristol, 39 Whatley Road, Clifton BS8 2PS, UK. Electronic address: c.salisbury@bristol.ac.uk.
authors.forename: Christopher
authors.initials: C
authors.lastname: Salisbury
mesh_terms: D002318:Cardiovascular Diseases / Q000517:prevention & control*; D016206:Databases, Bibliographic; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011322:Primary Prevention / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D017216:Telemedicine / Q000379:methods*
keywords: CVD; Cardiovascular disease; Primary prevention; Risk factors; Telehealth; Telemedicine