Effectiveness of telemedicine for cardiovascular disease management: systematic review and meta-analysis

Background: With the development of information communication technology (ICT), telemedicine has become a promising option for patients with chronic diseases who need continuous monitoring at home or in remote health care facilities. As cardiovascular disease (CVD) is responsible for an estimated 17.9 million deaths globally each year, it is appropriate to evaluate the effectiveness of telemedicine for the health care management of CVD patients. Methods: The Library of Congress, LISTA (EBSCO), PubMed (NLM), and Web of Science databases were searched with a date limitation from 1 January 2000 until 5 August 2021 for Randomized Controlled Trial (RCT) studies. Two independent researchers screened the records for inclusion and extracted the data for synthesis, supported by RevMan 5.0 software. As one of the clinical outcomes, the mean difference and standard deviation of systolic blood pressure were synthesized. For the Quality-of-life measures, EuroQol5D (EQ-5D) scores were also synthesized and for the depression level, CESD-10 scores were synthesized. Results: We identified 23 studies for qualitative analysis and 21 studies for quantitative analysis. 21 studies included systolic blood pressure as an outcome measure and the results show a statistical difference (P<0.05) between the intervention group and the control group and a favorable inclination toward the Telemedicine enhanced health care program over the usual care. Of the six studies that included body mass index (BMI) as an outcome measure, there was no significant difference in BMI between the telemedicine and usual health care groups. A total of five studies assessed patients' quality of life using the EQ-5D instrument. After excluding one study following the sensitivity analysis, telemedicine was shown to significantly improve patients' quality of life. Three studies that investigated patients' mental health (CSE-D-10) also showed a significantly beneficial effect of telemedicine over usual health care. Discussion: This review found limited evidence to support some of the outcomes in the original study designs. Overall, our findings suggested a favorable effect of telemedicine intervention in the field of health care for CVD patients. Due to the unavoidable heterogeneity within the selected literature, a more detailed investigation and analysis of the unclear outcomes is recommended.