Mortality benefit of a fourth-generation synchronous telehealth program for the management of chronic cardiovascular disease: A longitudinal study

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. ©chi-sheng hung,jiun-yu yu,yen-hung lin,ying-hsien chen,ching-chang huang,jen-kuang lee,pao-yu chuang,yi-lwun ho,ming-fong chen.