Telehealth interventions for the secondary prevention of coronary heart disease: a systematic review and meta-analysis

Background - Coronary heart disease (CHD) is a major cause of death worldwide. Cardiac rehabilitation (CR), an evidence-based CHD secondary prevention programme, remains underutilised. Telehealth may offer an innovative solution to overcome barriers to CR attendance. We aimed to determine whether contemporary telehealth interventions can provide effective secondary prevention as an alternative or adjunct care compared with CR and/or usual care for patients with CHD.Methods - Relevant randomized controlled trials (RCTs) evaluating telehealth interventions in CHD patients with at least 3-months follow-up compared with CR and/or usual care were identified by searching electronic databases. We checked reference lists, relevant conference lists, grey literature, and keyword searching of the Internet. Main outcomes included all-cause mortality, rehospitalisation/cardiac events and modifiable risk factors. (PROSPERO registration number 77507).Results - In total, 32 papers reporting 30 unique trials were identified. Telehealth were not significant associated with a lower all-cause mortality than CR and/or usual care [Risk ratio (RR)=0.60, 95% CI=0.86 to 1.24, P=0.42]. Telehealth were significantly associated with lower rehospitalisation or cardiac events (RR=0.56, 95% CI=0.39 to 0.81;