Telehealth in the Elderly with Chronic Heart Failure: What Is the Evidence?

摘要

Background: In a series of studies over the past decade we have measured the effectiveness of telehealth for elderly heart failure patients (>70 years) on rehospitalisation, mortality, adherence, satisfaction, cost effectiveness, health related quality of life, age and types of technology. Methods: Evidence has been derived from a Cochrane systematic review and meta-analysis (1 original and 2 updates: 2007-2016), two sub-analysis of this data and a large NHMRC funded multicentre randomised controlled trial (CHAT study 2010). Results: Within the studies included in the meta-analysis the mean age was 70 or more years in eight of the 16 (n=2,659/5,613; 47%) involving structured telephone support studies and four of the 11 (n=894/2,710; 33%) Telemonitoring studies. Structured telephone support (RR 0.80; 95% CI=0.63-l .00) and Telemonitoring (RR 0.56; 95% CI=0.41-0.76) interventions reduced mortality. Structured telephone support interventions reduced heart failure-related hospitalizations (RR 0.81; 95% CI=0.67-0.99). Four different types of non-invasive remote monitoring technologies were identified, including structured telephone calls, videophone, interactive voice response devices, and Telemonitoring. Structured telephone calls and Telemonitoring were effective in reducing the risk of all-cause mortality (relative risk [RR]=0.87; 95% confidence interval [CI], 0.75-1.01; p=0.06; and RR=0.62; 95% CI, 0.50-0.77; p<0.0001, respectively) and heart failure-related hospitalizations (RR=0.77; 95% CI, 0.68— 0.87;p<0.001; and RR=0.75; 95% CI, 0.63-0.91; p=0.003, respectively). Videophone and interactive voice response technologies were not effective. Only 3% of this elderly group (mean age 74.7+/-9.3 years) were unable to learn or competently use the technology. Adherence was reported between 55.1 %and 98.5%. Participant satisfaction with Telehealth was reported between 76% and 97%. Conclusion: These studies show that elderly patients can adapt quickly to telehealth, find its use an acceptable part of their healthcare routine, and are able to maintain good adherence for at least 12 months. These findings support the use of telehealth as part of a comprehensive chronic heart failure management programme.goes here.