%0 Journal Article
%@ 1438-8871
%I JMIR Publications Inc.
%V 18
%N 5
%P e102
%T Mortality Benefit of a Fourth-Generation Synchronous Telehealth Program for the Management of Chronic Cardiovascular Disease: A Longitudinal Study
%A Hung,Chi-Sheng
%A Yu,Jiun-Yu
%A Lin,Yen-Hung
%A Chen,Ying-Hsien
%A Huang,Ching-Chang
%A Lee,Jen-Kuang
%A Chuang,Pao-Yu
%A Ho,Yi-Lwun
%A Chen,Ming-Fong
%+ Telehealth Center, National Taiwan University Hospital, #7, Chung-Shan South Road, Taipei, Taiwan, Taipei, , Taiwan, 886 223123456 ext 62152, ylho@ntu.edu.tw
%K cardiovascular diseases
%K telemedicine
%K all-cause mortality
%K outcome assessment (health care)
%D 2016
%7 13.05.2016
%9 Original Paper
%J J Med Internet Res
%G English
%X 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. 
%M 27177497
%R 10.2196/jmir.5718
%U http://www.jmir.org/2016/5/e102/
%U https://doi.org/10.2196/jmir.5718
%U http://www.ncbi.nlm.nih.gov/pubmed/27177497