Abstract
BackgroundThere has been growing interest regarding the impact of telemonitoring and its ability to reduce the increasing burden of chronic diseases, including chronic cardiovascular disease (CVD), on healthcare systems. A number of randomised trials have been undertaken internationally and synthesised into various systematic reviews to establish an evidence base for this model of care. This study sought to synthesise and critically evaluate this large body of evidence to inform clinicians, researchers and policy makers.MethodsA systematic review of systematic reviews investigating the impact of telemonitoring interventions in the primary care management of CVD was conducted. Reviews were included if they explored primary care based telemonitoring in either CVD, heart failure or hypertension, were reported in the English language and were published between 2000 and 2013. Data was extracted by one reviewer and checked by a second reviewer using a standardised form. Two assessors then rated the quality of each review using the Overview Quality Assessment Questionnaire (OQAQ).ResultsOf the 13 included reviews, four focused on telemonitoring interventions in hypertension or CVD management and the remaining 9 reviews investigated telemonitoring in HF management. Seven reviews scored a five or above on the OQAQ evidencing good quality reviews. Findings suggest that telemonitoring can contribute to significant reductions in blood pressure, decreased all-cause and HF related hospitalisations, reduced all-cause mortality and improved quality of life. Telemonitoring was also demonstrated to reduce health care costs and appears acceptable to patients.ConclusionTelemonitoring has the potential to enhance primary care management of CVD by improving patient outcomes and reducing health costs. However, further research needs to explore the specific elements of telemonitoring interventions to determine the relative value of the various elements. Additionally, the ways in which telemonitoring care improves health outcomes needs to be further explored to understand the nature of these interventions.
Highlights
There has been growing interest regarding the impact of telemonitoring and its ability to reduce the increasing burden of chronic diseases, including chronic cardiovascular disease (CVD), on healthcare systems
Papers were excluded if they did not distinguish individuals with CVD from those in other disease groups, the intervention did not involve information transmission between the consumer and health provider or did not report a formal systematic review
This systematic review of systematic reviews found that the use of telemonitoring for patients with hypertension and heart failure (HF) was associated with multiple benefits
Summary
There has been growing interest regarding the impact of telemonitoring and its ability to reduce the increasing burden of chronic diseases, including chronic cardiovascular disease (CVD), on healthcare systems. A number of randomised trials have been undertaken internationally and synthesised into various systematic reviews to establish an evidence base for this model of care. The growing burden of the group of diseases that comprise cardiovascular disease (CVD) on national healthcare systems is well recognised amongst healthcare professionals internationally. Improved acute care, advanced intervention techniques, early diagnostic procedures, and worldwide demographic ageing have resulted in an increasing number of patients living with chronic CVD [3,4]. Implementation of evidence based hypertension management has the potential to reduce the prevalence of HF and, subsequently, reduce HF burden. Given the interrelationship and progressive nature of cardiac disease in primary care, there are advantages in considering the impact of management strategies across the disease silos
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