Telemedicine acceptance and efficacy in the context of preventive cardiology interventions: A systematic review.

Introduction: Telemedicine is being used in an increasing number of healthy lifestyle intervention studies in preventive cardiology. However, the optimal telemedicine-based approach for patients with cardiovascular disease remains unclear. Therefore, the aim of this systematic review is to identify which design features are associated with the acceptance and efficacy of telemedicine in this specific patient population. Methods: The databases PubMed/MEDLINE, Embase and the Web of Science Core Collection were searched from 5 October 2010 to 5 October 2020. This systematic review only included randomized controlled or quasi-randomized controlled trials with a comparator to a telemedicine-based intervention group and a designated measure of adherence. We adopted a narrative synthesis approach to define telemedical design features, which were clustered into three main categories (social, exercise related and barrier removal) and compared to adherence (graded as good, medium and bad) and primary outcomes (significant improvement, no significant change). Results: We screened a total of 865 records, of which 14 were included in this review, containing 13 identified design features. In 8 studies (57.1%), adherence was graded as good (4 studies medium, 2 studies bad). A positive primary outcome occurred in 10 (71.4%) studies. Personal contact showed the most pronounced (while not statistically significant) positive association with adherence and study outcomes. Conclusion: Given the remote nature of telemedical lifestyle intervention studies, including recurring personal contact in the intervention seems to be a key factor in ensuring that adherence levels remain comparable to those seen in centre-based interventions.