Effects of home telemonitoring interventions on patients with chronic heart failure: an overview of systematic reviews.
Effects of home telemonitoring interventions on patients with chronic heart failure: an overview of systematic reviews.
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DOI：
10.2196/jmir.4174
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发表时间：
2015-03-12
影响因子：
7.4
通讯作者：
Jaana M
中科院分区：
文献类型：
--
作者：
Kitsiou S;Paré G;Jaana M
对家庭远程监护对慢性心力衰竭（HF）患者的影响越来越感兴趣，导致解决相同或非常相似的研究问题的系统性综述数量增加，同时不一致的结果也随之增加。系统评价的范围、分析方法和方法学质量的差异可能会造成极大的混乱，使决策者和临床医生难以获得和解释现有证据，使研究人员难以了解现有文献中存在的知识差距。本综述旨在收集、评估和综合多项系统性综述中关于慢性心力衰竭（HF）患者家庭远程监护干预措施有效性的现有证据，以告知政策制定者、从业者和研究人员。对MEDLINE、EMBASE、CINAHL和科克伦图书馆进行了全面的文献检索，以识别1996年1月至2013年12月期间发表的所有相关、同行评审的系统性综述。使用明确的关键词和纳入标准对综述进行检索和筛选。使用标准化表格提取数据，并使用AMSTAR（评估系统性综述的方法学质量）工具评估纳入综述的方法学质量。为所有主要关注结果构建了结果汇总表，并使用GRADE（推荐、评估、发展和评价等级）系统按结果对证据质量进行分级。进行了事后分析和亚组荟萃分析，以进一步了解系统综述中包含的各种类型的家庭远程监护技术以及这些技术对临床结局的影响。2003年至2013年期间发表的15篇综述被选为元水平综合。来自高质量综述和荟萃分析的证据表明，与常规护理相比，家庭远程监护干预措施可降低全因死亡率（0.60至0.85）和心力衰竭相关住院（0.64至0.86）的相对风险。绝对风险降低范围分别为1.4%-6.5%和3.7%-8.2%。HF相关住院治疗的改善似乎在稳定HF患者中更为明显：风险比（HR）0.70（95%可信区间[Crl] 0.34-1.5]）。在近期HF急性加重后从急性护理环境中出院（≤28天）的患者中，死亡率和全因住院的风险降低似乎更大：HR分别为0.62（95% CrI 0.42-0.89）和HR 0.67（95% CrI 0.42-0.97）。然而，这些结果的证据质量从中等到低不等，表明进一步的研究很可能对我们对观察到的效果估计的信心产生重要影响，并可能改变这些估计。事后分析确定了系统性综述中包括的五种主要类型的无创远程监护技术：（1）视频会诊，有或没有生命体征传输，（2）移动的远程监护，（3）基于自动设备的远程监护，（4）交互式语音应答，（5）基于Web的远程监护。其中，只有基于自动化设备的远程监护和移动的远程监护可有效降低全因死亡率和HF相关住院的风险。交互式语音应答系统、视频咨询和基于网络的远程监护需要更多的研究数据，以提供关于其有效性的可靠结论。未来的研究应侧重于了解家庭远程监护在改善结局方面的工作过程，确定最佳策略和随访时间，并进一步调查慢性HF患者群体和家庭远程监护技术类型之间是否存在差异有效性。
Growing interest on the effects of home telemonitoring on patients with chronic heart failure (HF) has led to a rise in the number of systematic reviews addressing the same or very similar research questions with a concomitant increase in discordant findings. Differences in the scope, methods of analysis, and methodological quality of systematic reviews can cause great confusion and make it difficult for policy makers and clinicians to access and interpret the available evidence and for researchers to know where knowledge gaps in the extant literature exist. This overview aims to collect, appraise, and synthesize existing evidence from multiple systematic reviews on the effectiveness of home telemonitoring interventions for patients with chronic heart failure (HF) to inform policy makers, practitioners, and researchers. A comprehensive literature search was performed on MEDLINE, EMBASE, CINAHL, and the Cochrane Library to identify all relevant, peer-reviewed systematic reviews published between January 1996 and December 2013. Reviews were searched and screened using explicit keywords and inclusion criteria. Standardized forms were used to extract data and the methodological quality of included reviews was appraised using the AMSTAR (assessing methodological quality of systematic reviews) instrument. Summary of findings tables were constructed for all primary outcomes of interest, and quality of evidence was graded by outcome using the GRADE (Grades of Recommendation, Assessment, Development, and Evaluation) system. Post-hoc analysis and subgroup meta-analyses were conducted to gain further insights into the various types of home telemonitoring technologies included in the systematic reviews and the impact of these technologies on clinical outcomes. A total of 15 reviews published between 2003 and 2013 were selected for meta-level synthesis. Evidence from high-quality reviews with meta-analysis indicated that taken collectively, home telemonitoring interventions reduce the relative risk of all-cause mortality (0.60 to 0.85) and heart failure-related hospitalizations (0.64 to 0.86) compared with usual care. Absolute risk reductions ranged from 1.4%-6.5% and 3.7%-8.2%, respectively. Improvements in HF-related hospitalizations appeared to be more pronounced in patients with stable HF: hazard ratio (HR) 0.70 (95% credible interval [Crl] 0.34-1.5]). Risk reductions in mortality and all-cause hospitalizations appeared to be greater in patients who had been recently discharged (≤28 days) from an acute care setting after a recent HF exacerbation: HR 0.62 (95% CrI 0.42-0.89) and HR 0.67 (95% CrI 0.42-0.97), respectively. However, quality of evidence for these outcomes ranged from moderate to low suggesting that further research is very likely to have an important impact on our confidence in the observed estimates of effect and may change these estimates. The post-hoc analysis identified five main types of non-invasive telemonitoring technologies included in the systematic reviews: (1) video-consultation, with or without transmission of vital signs, (2) mobile telemonitoring, (3) automated device-based telemonitoring, (4) interactive voice response, and (5) Web-based telemonitoring. Of these, only automated device-based telemonitoring and mobile telemonitoring were effective in reducing the risk of all-cause mortality and HF-related hospitalizations. More research data are required for interactive voice response systems, video-consultation, and Web-based telemonitoring to provide robust conclusions about their effectiveness. Future research should focus on understanding the process by which home telemonitoring works in terms of improving outcomes, identify optimal strategies and the duration of follow-up for which it confers benefits, and further investigate whether there is differential effectiveness between chronic HF patient groups and types of home telemonitoring technologies.
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影响因子：
2.1
作者：
Giamouzis G;Mastrogiannis D;Koutrakis K;Karayannis G;Parisis C;Rountas C;Adreanides E;Dafoulas GE;Stafylas PC;Skoularigis J;Giacomelli S;Olivari Z;Triposkiadis F
通讯作者：
Triposkiadis F
影响因子：
49.6
作者：
Bui, Anh L.;Horwich, Tamara B.;Fonarow, Gregg C.
通讯作者：
Fonarow, Gregg C.
影响因子：
7.2
作者：
Guyatt, Gordon H.;Oxman, Andrew D.;Schuenemann, Holger J.
通讯作者：
Schuenemann, Holger J.
影响因子：
7.2
作者：
Guyatt, Gordon H.;Oxman, Andrew D.;Schuenemann, Holger J.
通讯作者：
Schuenemann, Holger J.
影响因子：
7.2
作者：
Guyatt, Gordon H.;Oxman, Andrew D.;Schuenemann, Holger J.
通讯作者：
Schuenemann, Holger J.