Abstract 16282: Telemedicine Application in the Care of Acute Myocardial Infarction Patients: Systematic Review and Meta-Analysis
Introduction: Telemedicine strategies have the potential to increase healthcare professionals’ adherence to the therapeutic measures established for acute myocardial infarction (MI), to improve MI care. However, the real impact of this intervention in clinical outcomes is still unknown or poorly documented. Our aim is to conduct a systematic review and meta-analysis of studies assessing the impact of telemedicine interventions combined with usual care compared to usual care alone on AMI mortality.
Methods: Electronic databases MEDLINE, Cochrane Central Register of Controlled Trials, LILACS, BDENF, IBECs, Web of Science, Scopus and Google Scholar were searched to identify relevant studies published from Jan/2004 to May/2015. The search was supplemented by references from the selected articles. Study search and selection were performed by independent reviewers. Random effects model was applied to estimate the pooled results. Methodological quality of non-randomized studies was assessed by Newcastle Ottawa scale (NOS).
Results: Of the 5.407 articles retrieved, 16 studies (8,945 patients) were included: 8 in Europe, 5 in North America, 2 in South America and 1 in Asia. No randomized controlled trial was identified; 13 studies were nonrandomized controlled, 3 historically controlled, and 1 quasi-experimental. Fourteen studies were in ST elevation MI patients, and in 14 studies the intervention involved prehospital ECG and transmission to the emergency physician or cardiologist of a percutaneous coronary intervention center. The studies were classified as moderate quality by NOS. Telemedicine was associated with a statistically significant reduction in in-hospital mortality (12 studies [n=6033], risk ratio [RR] 0.54 [CI 95% 0.46-0.64], I2 <0.01%, no evidence of publication bias), 30-day mortality (5 studies [n=3506], RR 0.67 [CI 95% 0.49-0.95], I2 23%, no evidence of publication bias) and one-year mortality (3 studies[n=1549], RR 0.47 [IC 95% 0.33-0.68], I2 <0.01%). In sensitivity analyses, studies were individually omitted from the meta-analysis, and the RR remained about the same.
Conclusions: Telemedicine strategies combined with the usual care for MI patients are associated with improved in-hospital, 30-day and one-year mortality.
Author Disclosures: M.S. Marcolino: None. L.M. Maia: None. J.A. Oliveira: None. D.F. Andrade-Junior: None. B.L. Pereira: None. A.L. Ribeiro: None.
- © 2016 by American Heart Association, Inc.