Authors' objectives: This report reviews the literature on assessment of telecardiology, considering applications in pediatric care, hospital or clinic use for adults, emergency care, and home care.

Authors' recommendations: From 527 publications identified in the literature search, 46 papers describing 44 studies met the selection criteria and were included in the review. The majority of the studies (39 of 44) concluded that telecardiology had advantages over the alternative. However, the quality of 23 of these (59%) was poor or poor to fair. All but one of the studies on pediatric applications related to teletransmission of echocardiography data. Reported benefits included savings in time and cost through avoiding unnecessary referrals. Three studies were of fair quality, with the remainder providing weaker evidence. Economic analyses in six studies were of low or very low quality. The other pediatric study, on monitoring of pacemaker performance, provided weak evidence of benefit. Six of ten studies on applications in adult care considered support for primary care physicians through transmission of ECG results and feedback from cardiologists. There were benefits through avoidance of unnecessary referrals and identification of patients who required urgent intervention. One study was judged to be fair, with the others having lower reliability. Two other studies indicated benefits from use of telecardiology in a prison service and in support of a cardiac catheterization laboratory. Feasibility was demonstrated, but benefits were less clear, in studies on use of telemetry outside critical care units and on transmission of nuclear medicine results. With emergency care applications three studies considered transmission of ECG data from ambulance to hospital and indicated benefits through faster diagnosis and more rapid treatment of patients. One of these studies was of good quality with the others giving weaker evidence. A good quality study on use of dobutamine stress echocardiography demonstrated benefits through avoidance of unnecessary hospitalization. A fair quality study indicated benefits from use of a faxbased system to provide out of hours support to hospital house officers. Nine of 13 home care application studies assessed telemonitoring of patients with heart failure. Benefits were demonstrated through reduction in hospital admissions, decreased hospital stay, and lower hospital costs. Four studies were RCTs of high quality, two were judged to be fair and three were poor to fair. One of the high quality studies also rated as fair to good for its economic analysis. Two high quality studies showed that homebased rehabilitation was as effective as programs undertaken within institutions. One good quality and one poor quality study indicated useful gains in performance in the monitoring of arrhythmias. The review shows that few studies of telecardiology in the recent literature have reported clinical or economic outcomes. On the basis of information given in the papers that were reviewed, the quality of over half the 44 studies were judged to be of poor or poor to fair. For decision-making purposes, they should be regarded as providing no more than preliminary indications of benefits and costs, requiring follow up to verify their findings. While telecardiology has had a long history, most of the studies reported in the literature do not provide convincing evidence of benefit. Decision makers should note the need for follow-up of preliminary studies in order to obtain reliable outcomes data for telecardiology applications.

Authors' methods: Systematic review

Project Status: Completed

Year Published: 2004

URL for published report: http://www.ihe.ca/advanced-search/evidence-for-the-benefits-of-telecardiology-applications-a-systematic-review

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Canada

Organisation Name: Institute of Health Economics

Contact Address: 1200, 10405 Jasper Avenue, Edmonton, Alberta, Canada, T5J 3N4. Tel: +1 780 448 4881; Fax: +1 780 448 0018;

Contact Name: djuzwishin@ihe.ca

Contact Email: djuzwishin@ihe.ca

Copyright: <p>Alberta Heritage Foundation for Medical Research (AHFMR)</p>