title: Mortality Benefit of a Fourth-Generation Synchronous Telehealth Program for the Management of Chronic Cardiovascular Disease: A Longitudinal Study.
abstract: BACKGROUND
  We have shown that a fourth-generation telehealth program that analyzes and responds synchronously to data transferred from patients is associated with fewer hospitalizations and lower medical costs. Whether a fourth-generation telehealth program can reduce all-cause mortality has not yet been reported for patients with chronic cardiovascular disease.
  
  
  OBJECTIVE
  We conducted a clinical epidemiology study retrospectively to determine whether a fourth-generation telehealth program can reduce all-cause mortality for patients with chronic cardiovascular disease.
  
  
  METHODS
  We enrolled 576 patients who had joined a telehealth program and compared them with 1178 control patients. A Cox proportional hazards model was fitted to analyze the impact of risk predictors on all-cause mortality. The model adjusted for age, sex, and chronic comorbidities.
  
  
  RESULTS
  There were 53 (9.3%) deaths in the telehealth group and 136 (11.54%) deaths in the control group. We found that the telehealth program violated the proportional hazards assumption by the Schoenfeld residual test. Thus, we fitted a Cox regression model with time-varying covariates. The results showed an estimated hazard ratio (HR) of 0.866 (95% CI 0.837-0.896, P<.001; number needed to treat at 1 year=55.6, 95% CI 43.2-75.7 based on HR of telehealth program) for the telehealth program on all-cause mortality after adjusting for age, sex, and comorbidities. The time-varying interaction term in this analysis showed that the beneficial effect of telehealth would increase over time.
  
  
  CONCLUSIONS
  The results suggest that our fourth-generation telehealth program is associated with less all-cause mortality compared with usual care after adjusting for chronic comorbidities.
authors.affiliation: Telehealth Center, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Chi-Sheng
authors.identifier: http://orcid.org/0000-0002-0158-7232
authors.initials: CS
authors.lastname: Hung
authors.forename: Jiun-Yu
authors.identifier: http://orcid.org/0000-0002-9517-1667
authors.initials: JY
authors.lastname: Yu
authors.forename: Yen-Hung
authors.identifier: http://orcid.org/0000-0001-8153-1441
authors.initials: YH
authors.lastname: Lin
authors.forename: Ying-Hsien
authors.identifier: http://orcid.org/0000-0003-2746-4967
authors.initials: YH
authors.lastname: Chen
authors.forename: Ching-Chang
authors.identifier: http://orcid.org/0000-0001-8733-6217
authors.initials: CC
authors.lastname: Huang
authors.forename: Jen-Kuang
authors.identifier: http://orcid.org/0000-0003-3790-484X
authors.initials: JK
authors.lastname: Lee
authors.forename: Pao-Yu
authors.identifier: http://orcid.org/0000-0002-8618-6912
authors.initials: PY
authors.lastname: Chuang
authors.forename: Yi-Lwun
authors.identifier: http://orcid.org/0000-0002-8936-9570
authors.initials: YL
authors.lastname: Ho
authors.forename: Ming-Fong
authors.identifier: http://orcid.org/0000-0001-6633-7632
authors.initials: MF
authors.lastname: Chen
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000401:mortality* / Q000628:therapy*; D002423:Cause of Death; D002908:Chronic Disease; D015897:Comorbidity; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D017216:Telemedicine / Q000379:methods*; D013997:Time Factors
keywords: all-cause mortality; cardiovascular diseases; outcome assessment (health care); telemedicine