The effectiveness of Telemedicine on Patients after Percutaneous Coronary Intervention: a Systematic Review and Meta-analysis of Randomized Controlled Trials (Preprint)

Abstract

BACKGROUND Cardiovascular disease has become the leading cause of death for patients worldwide, and deaths due to cardiovascular disease accounted for one-third of all deaths worldwide in 2019. Percutaneous Coronary Intervention (PCI), as the most commonly used revascularization method for clinical treatment of coronary artery disease, can effectively improve myocardial ischemia and hypoxia symptoms. Telemedicine can enhance patient monitoring, facilitate early identification and analysis of patient conditions, enhancing patient management and quality of care. The European Society of Cardiology (ESC) state that postoperative management such as lipid-lowering therapy, anticoagulation therapy and lifestyle changes can reduce the rate of coronary restenosis in patients. However, patients with low medication adherence and poor self-management after PCI are prone to complications such as restenosis . Studies have shown that home-based telehealth interventions in the postoperative management of PCI patients can effectively improve the lack of post-treatment management , improve patients' medication adherence, and lead to a significant decrease in coronary heart disease mortality and rehospitalization rates. Telemedicine is the support of medical and public health services through mobile wireless network devices, such as the use of cell phones, wearable systems, Personal Digital Assistant, and other wireless devices for patient health management. OBJECTIVE The purpose of this study was to evaluate the effectiveness of telemedicine intervention on patients after percutaneous coronary intervention (PCI). METHODS PubMed, Cochrane Central Register of Controlled Trials, Embase, Web of Science, and four Chinese databases were searched to 1 July 2022. We included randomized controlled trials (RCTs), comparing the prognostic effect of conventional care and telemedicine intervention on patients after PCI. RESULTS Totally 11 studies with 2360 participants were included. The results showed that telemedicine versus conventional treatment led to a reduction in cardiovascular events(Risk Ratio-RR 0.62;95% confidence interval-CI 0.42–0.91; P=.02) and smoking cessation status(RR 1.56; 95 % CI 1.06–2.30; P=.02), improving quality of life(Standard Mean Difference-SMD 2.91; 95% CI 1.22–4.59; P<.001). Both total cholesterol (Mean Difference-MD -0.33; 95%CI -0.54 –-0.12; P<.002) and triglycerides (MD, -0.23; 95% CI -0.31 – -0.14; P<.001) were significantly lower in the telemedicine group than in the control group. There was no significant effect on systolic blood pressure, diastolic blood pressure, low-density lipoprotein, high-density lipoprotein, or body mass index(P＞.05). CONCLUSIONS Telemedicine-based nursing interventions effectively improve cardiovascular events and quality of life in patients after PCI. However, due to the limitations of the number and quality of included studies, the above findings require further investigation.