Telemedicine May Reduce CV-Related Mortality Risk in Patients with Heart Failure

Atul Anand, PhD

Combined remote telemedicine monitoring and consultation might reduce short-term cardiovascular-related hospitalization and mortality risk among patients with heart failure compared with usual care, according to new findings.

However, this observed effect was not reported with simple remote access to a healthcare professional without additional monitoring data.

“These findings suggest a definite role for telemedicine in the management of heart failure, particularly in early treatment optimization, but the value is less clear for long-term management strategy and other cardiovascular diseases,” wrote study author Dr Atul Anand, British Heart Foundation Center for Cardiovascular Science, University of Edinburgh.

Digital health interventions (DHIs) have the ability to transform the diagnosis and management of chronic cardiovascular conditions and saw a rapid adoption during the COVID-19 pandemic. Anand and colleagues performed a systematic review and meta-analysis of studies in which the effectiveness of telemedicine interventions for the management of patients with cardiovascular conditions was reported.

They searched PubMed, Scopus, and Cochrane Library from inception of the database to January 2021. They included any study that evaluated the effects of a telemedicine intervention on cardiovascular outcomes for individuals either at risk of cardiovascular disease (CVD) or with established CVD.

Primary outcomes were identified as cardiovascular-related mortality, followed by secondary outcomes including hospitalization secondary to cardiovascular causes, all-cause mortality, and all-cause hospitalization.

A total of 72 studies were included in the systematic review and included 127,869 participants who met eligibility criteria. The patients were 65% (n = 82,816) male and 35% (n = 45,051) female.

Then, 34 studies contributed data considered appropriate for meta-analysis and included a total of 13,269 participants (65% male [n = 8629] and 35% female [n = 4640]). From this population, 6620 (50%) were assigned to telemedicine and 6649 (50%) received usual clinical care.

The data suggest combined remote monitoring and consultation was associated with a reduced risk of cardiovascular-related mortality in heart failure patients (risk ratio [RR], 0.83; 95% confidence interval [CI], 0.70 - 0.99; P = .036).

There was no overall benefit observed in cardiovascular mortality risk in three studies using remote consultation techniques alone (n = 572; RR, 0.97, 95% CI, 0.63 - 1.47).

Moreover, telemedicine interventions combining remote monitoring and consultation were associated with a reduction in the risk of cardiovascular hospitalizations (RR, 0.71; 95% CI, 0.58 - 0.87; P = .0002).

Further, there were no significant changes in all-cause hospitalization risk following a telemedicine remote monitoring intervention (RR, 1.02 [95% CI, 0.94 - 1.10; P = .71) or mortality (RR, 0.90 [95% CI, 0.77 - 1.06); P = .23).

Investigators found small reductions for systolic blood pressure (mean difference, –3.59 [95% CI, -5.35 to -1.83] mm Hg; P <.0001) with the combination of remote monitoring and consultation in secondary prevention populations.

They suggested the average risk reduction of cardiovascular-related hospitalization (28%) in patients with heart failure had notable heterogeneity, with greatest reduction seen within 12 months or intervention and no effectiveness with longer follow-up.

“These results might suggest early gains from implementing telemedicine interventions in this group, but perhaps less success in patients with progressive or more advanced heart failure,” Anand added.

The study, “Efficacy of telemedicine for the management of cardiovascular disease: a systematic review and meta-analysis,” was published in The Lancet Digital Health.