Telemedicine for the Reduction of Myocardial Infarction Mortality: A Systematic Review and a Meta-Analysis of Published Studies

Introduction: Advances in electronics and communications have changed modern medicine: telemedicine allows patient assessment and monitoring to facilitate healthcare at a distance. The aim of this study was to perform a systematic review and meta-analysis to assess how telemedicine systems, including early telemetry of electrocardiograms, can improve health outcomes in patients with coronary artery disease and, in particular, acute myocardial infarction (AMI). Methods: Studies dealing with telemedicine applications in managing AMI that were conducted before January 22, 2010, published in English or Italian, were identified in PubMed and ISI Web of Knowledge searches. The meta-analysis was performed to assess the efficacy of telemedicine versus standard measures in reducing mortality. Relative risk (RR) with 95% confidence interval was used to report results and the I(2) test to evaluate heterogeneity. Results: Five of the 39 articles retrieved were selected; all studies demonstrated the efficacy of telemedicine applications. Only three studies were judged to be comparable and suitable for combining data. This meta-analysis showed that the RR for in-hospital mortality from AMI was 0.65 (95% confidence interval, 0.42-0.99) for the telemedicine group, without heterogeneity. Conclusions: Telemedicine may improve health outcomes of patients with AMI. However, heterogeneity in study design and end points of most studies limited the number of articles that could be subjected to our meta-analysis.