@Article{info:doi/10.2196/jmir.5718,
author="Hung, Chi-Sheng
and Yu, Jiun-Yu
and Lin, Yen-Hung
and Chen, Ying-Hsien
and Huang, Ching-Chang
and Lee, Jen-Kuang
and Chuang, Pao-Yu
and Ho, Yi-Lwun
and Chen, Ming-Fong",
title="Mortality Benefit of a Fourth-Generation Synchronous Telehealth Program for the Management of Chronic Cardiovascular Disease: A Longitudinal Study",
journal="J Med Internet Res",
year="2016",
month="May",
day="13",
volume="18",
number="5",
pages="e102",
keywords="cardiovascular diseases; telemedicine; all-cause mortality; outcome assessment (health care)",
abstract="Background: We have shown that a fourth-generation telehealth program that analyzes and responds synchronously to data transferred from patients is associated with fewer hospitalizations and lower medical costs. Whether a fourth-generation telehealth program can reduce all-cause mortality has not yet been reported for patients with chronic cardiovascular disease. Objective: We conducted a clinical epidemiology study retrospectively to determine whether a fourth-generation telehealth program can reduce all-cause mortality for patients with chronic cardiovascular disease. Methods: We enrolled 576 patients who had joined a telehealth program and compared them with 1178 control patients. A Cox proportional hazards model was fitted to analyze the impact of risk predictors on all-cause mortality. The model adjusted for age, sex, and chronic comorbidities. Results: There were 53 (9.3{\%}) deaths in the telehealth group and 136 (11.54{\%}) deaths in the control group. We found that the telehealth program violated the proportional hazards assumption by the Schoenfeld residual test. Thus, we fitted a Cox regression model with time-varying covariates. The results showed an estimated hazard ratio (HR) of 0.866 (95{\%} CI 0.837-0.896, P<.001; number needed to treat at 1 year=55.6, 95{\%} CI 43.2-75.7 based on HR of telehealth program) for the telehealth program on all-cause mortality after adjusting for age, sex, and comorbidities. The time-varying interaction term in this analysis showed that the beneficial effect of telehealth would increase over time. Conclusions: The results suggest that our fourth-generation telehealth program is associated with less all-cause mortality compared with usual care after adjusting for chronic comorbidities. ",
issn="1438-8871",
doi="10.2196/jmir.5718",
url="http://www.jmir.org/2016/5/e102/",
url="https://doi.org/10.2196/jmir.5718",
url="http://www.ncbi.nlm.nih.gov/pubmed/27177497"
}