Abstract
Background
Despite the strong uptake of mobile health (mhealth) technology targeted at cardiovascular
care, it is still unclear if this improves adherence to therapy and patient-related
outcomes in those with established cardiovascular disease.
Methods
A systematic search of English and Chinese language studies was conducted to investigate
the benefit of mhealth technology for the secondary prevention of cardiovascular disease.
Results
Twenty-seven studies with 5165 patients were included in the systematic review. Patients
in the mhealth group showed increased adherence to medical therapy (odds ratio [OR],
4.51; P < 0.00001), as well as increased adherence to pharmacologic and nonpharmacologic
therapy (OR, 3.86; P < 0.00001). Patients in the mhealth group showed the ability to meet recommended
blood pressure targets (OR, 2.80; P < 0.001) with a trend toward the ability to meet exercise goals (OR, 2.55; P = 0.07), however, no significant difference in smoking cessation (OR, 1.42; P = 0.45) and the ability to meet lipid target levels (OR, 1.16; P = 0.29) was found. Patients in the mhealth group did not show a reduction in hospital
readmission (OR, 0.93; P = 0.96), with a small number of studies showing a reduction in angina (OR, 0.23;
P = 0.005), and a decrease in transient ischemic attack/stroke recurrence in those
with cerebrovascular disease (OR, 0.18; P < 0.0001) and a trend toward lower observed mortality rate (OR, 0.19; P = 0.06).
Conclusions
The mhealth group compared with the usual care group had increased adherence to medical
therapy, ability to reach blood pressure targets, exercise goals, and showed less
anxiety and increased awareness of diet and exercise. There was no difference in smoking
cessation, ability to meet low-density lipoprotein cholesterol targets, and hospital
readmission.
Résumé
Introduction
En dépit de la forte intégration de la technologie en santé mobile (m-santé) orientée
vers les soins cardiovasculaires, on ignore encore si elle améliore l’observance au
traitement et les résultats cliniques des patients qui ont une maladie cardiovasculaire
établie.
Méthodes
Une revue systématique des études de langue anglaise et chinoise a été menée pour
examiner les avantages de la technologie en m-santé sur la prévention secondaire des
maladies cardiovasculaires.
Résultats
Vingt-sept études totalisant 5165 patients ont été incluses dans la revue systématique.
Les patients du groupe de m-santé ont montré une amélioration de l’observance au traitement
médical (ratio d’incidence approché [RIA], 4,51; P < 0,00001), ainsi qu’une amélioration de l’observance au traitement pharmacologique
et non pharmacologique (RIA, 3,86; P < 0,00001). Les patients du groupe de m-santé ont montré la capacité à atteindre
les valeurs cibles recommandées de la pression artérielle (RIA, 2,80; P < 0,001) et une tendance à la capacité à atteindre les objectifs de l’exercice physique
(RIA, 2,55; P = 0,07). Toutefois, aucune différence significative dans l’abandon du tabac (RIA,
1,42; P = 0,45) et la capacité à atteindre les valeurs cibles des concentrations de lipides
(RIA, 1,16; P = 0,29) n’a été observée. Les patients du groupe de m-santé n’ont pas montré de réduction
de la réadmission à l’hôpital (RIA, 0,93; P = 0,96), et de rares études ont montré une réduction de l’angine (RIA, 0,23; P = 0,005), et une diminution de la récurrence de l’ischémie cérébrale transitoire
et de l’accident vasculaire cérébral chez ceux ayant une maladie vasculaire cérébrale
(RIA, 0,18; P < 0,0001) et une tendance à l’observation d’un taux de mortalité plus faible (RIA,
0,19; P = 0,06).
Conclusions
Comparativement au groupe qui a reçu les soins usuels, le groupe de m-santé a montré
une amélioration de l’observance au traitement médical, de la capacité à atteindre
les valeurs cibles de la pression artérielle et les objectifs de l’exercice physique,
et a également montré une anxiété moindre et une sensibilisation accrue à l’alimentation
et à l’exercice physique. Aucune différence dans l’abandon du tabac, la capacité à
atteindre les valeurs cibles du cholestérol à lipoprotéines de faible densité et la
réadmission à l’hôpital n’a été notée.
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Article info
Publication history
Published online: September 13, 2016
Accepted:
August 25,
2016
Received:
June 19,
2016
Footnotes
See editorial by Stone, pages 216–218 of this issue.
See page 230 for disclosure information.
Identification
Copyright
© 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
