TY  - JOUR
AU  - Hung, Chi-Sheng
AU  - Yu, Jiun-Yu
AU  - Lin, Yen-Hung
AU  - Chen, Ying-Hsien
AU  - Huang, Ching-Chang
AU  - Lee, Jen-Kuang
AU  - Chuang, Pao-Yu
AU  - Ho, Yi-Lwun
AU  - Chen, Ming-Fong
PY  - 2016
DA  - 2016/05/13
TI  - Mortality Benefit of a Fourth-Generation Synchronous Telehealth Program for the Management of Chronic Cardiovascular Disease: A Longitudinal Study
JO  - J Med Internet Res
SP  - e102
VL  - 18
IS  - 5
KW  - cardiovascular diseases
KW  - telemedicine
KW  - all-cause mortality
KW  - outcome assessment (health care)
AB  - 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. 
SN  - 1438-8871
UR  - http://www.jmir.org/2016/5/e102/
UR  - https://doi.org/10.2196/jmir.5718
UR  - http://www.ncbi.nlm.nih.gov/pubmed/27177497
DO  - 10.2196/jmir.5718
ID  - info:doi/10.2196/jmir.5718
ER  -