Cost saving analysis of specialized, eHealth-based management of patients receiving oral anticoagulation therapy: Results from the thrombEVAL study

Eggebrecht, Lisa; Ludolph, Paul; Göbel, Sebastian; Panova‐Noeva, Marina; Arnold, Natalie; Nagler, Markus; Bickel, Christoph; Lauterbach, Michael; Hardt, Roland; Cate, Hugo Ten; Lackner, Karl J.; Espinola‐Klein, Christine; Münzel, Thomas; Prochaska, Jürgen H.; Wild, Philipp S.

doi:10.1038/s41598-021-82076-9

Cited by 5 publications

(3 citation statements)

References 32 publications

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“…Concerning costs, evidence is still lacking. In a recently published cost analysis of the ThrombEVAL study [ 52 ], the rise in direct costs was outweighed by the lower frequency of adverse events and hospitalizations in patients managed by telemedicine-based intervention, which led to an important reduction in health care expenditures. As cost and reimbursement barriers continue to limit the implementation of telemedicine services, future studies should conduct in-depth cost-effective analyses of the various types of telemedicine strategies to support anticoagulation management.…”

Section: Discussionmentioning

confidence: 99%

Telemedicine-Based Management of Oral Anticoagulation Therapy: Systematic Review and Meta-analysis

Arantes¹,

Abdulazeem²,

Weerasekara³

et al. 2023

J Med Internet Res

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Background Oral anticoagulation is the cornerstone treatment of several diseases. Its management is often challenging, and different telemedicine strategies have been implemented to support it. Objective The aim of the study is to systematically review the evidence on the impact of telemedicine-based oral anticoagulation management compared to usual care on thromboembolic and bleeding events. Methods Randomized controlled trials were searched in 5 databases from inception to September 2021. Two independent reviewers performed study selection and data extraction. Total thromboembolic events, major bleeding, mortality, and time in therapeutic range were assessed. Results were pooled using random effect models. Results In total, 25 randomized controlled trials were included (n=25,746 patients) and classified as moderate to high risk of bias by the Cochrane tool. Telemedicine resulted in lower rates of thromboembolic events, though not statistically significant (n=13 studies, relative risk [RR] 0.75, 95% CI 0.53-1.07; I2=42%), comparable rates of major bleeding (n=11 studies, RR 0.94, 95% CI 0.82-1.07; I2=0%) and mortality (n=12 studies, RR 0.96, 95% CI 0.78-1.20; I2=11%), and an improved time in therapeutic range (n=16 studies, mean difference 3.38, 95% CI 1.12-5.65; I2=90%). In the subgroup of the multitasking intervention, telemedicine resulted in an important reduction of thromboembolic events (RR 0.20, 95% CI 0.08-0.48). Conclusions Telemedicine-based oral anticoagulation management resulted in similar rates of major bleeding and mortality, a trend for fewer thromboembolic events, and better anticoagulation quality compared to standard care. Given the potential benefits of telemedicine-based care, such as greater access to remote populations or people with ambulatory restrictions, these findings may encourage further implementation of eHealth strategies for anticoagulation management, particularly as part of multifaceted interventions for integrated care of chronic diseases. Meanwhile, researchers should develop higher-quality evidence focusing on hard clinical outcomes, cost-effectiveness, and quality of life. Trial Registration PROSPERO International Prospective Register of Systematic Reviews CRD42020159208; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=159208

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Section: Discussionmentioning

confidence: 99%

Telemedicine-Based Management of Oral Anticoagulation Therapy: Systematic Review and Meta-analysis

Arantes¹,

Abdulazeem²,

Weerasekara³

et al. 2023

J Med Internet Res

View full text Add to dashboard Cite

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“…Finally, another aspect that may gain importance soon is the possibility of telemedicine-guided INR management to increase patient compliance, and improve oral anticoagulation quality. Some interesting trends have been observed during the pandemic while telemedicine and artificial intelligence may further boost such approaches (27)(28)(29).…”

Section: Anticoagulant Treatment Following Mechanical Valve Implantat...mentioning

confidence: 99%

Evolving technology: the TRIFLO tri-leaflet mechanical valve without oral anticoagulation: a potential major innovation in valve surgery

Carrel,

Vogt,

Obrist

et al. 2023

Front. Cardiovasc. Med.

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The aortic valve is the most frequently diseased valve and aortic stenosis (AS) is the most prevalent valvular heart disease in developed countries. The diseased native aortic valve can be replaced by either a biological or mechanical valve prosthesis. The main concerns relate to durability, the need for oral anticoagulants and the incidence of complications related to this medication. Experimental, computational and biomolecular blood flow studies have demonstrated that the systolic forward flow but also the reverse flow phase at the end of the systole and leakage during the diastolic phase is mainly responsible for platelet activation and thrombosis. Better design of mechanical prosthetic heart valves must ensure smooth closing during flow deceleration and must eliminate high-shear hinge flow during diastole to prevent life-threatening thrombosis. A novel tri-leaflet valve should combine the favorable hemodynamics and the durability of existing mechanical heart valves and eliminate the less favorable characteristics, including the extremely rapid closing. In this paper, we discuss some issues of current mechanical heart valve prostheses and present a new valve design with the potential for significant innovation in the field. The TRIFLO Heart Valve, is a rigid, three-leaflet central flow heart valve prosthesis consisting of an alloyed titanium housing, and three rigid polymer (PEEK) cusps. This valve has a physiological operating mode. During the forward flow phase, the intraventricular pressure opens the leaflets so that blood can freely flow through with little obstruction, and with the deceleration of the blood flow, the leaflets close early and smoothly, minimizing blood flow regurgitation, blood cell damage, and activation of the coagulation cascade. Pre-clinical studies have shown pretty favorable results and a first-in-man study should start very soon.

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“…Recent advancements in telemedicine are quickly making it a significant part of medical practice and research [3] [4]. To provide diagnosis, treatment, consultation, and training, telemedicine integrates medicine, telecommunications, information technology, and education [5] [6].…”

Section: Introductionmentioning

confidence: 99%

Bibliometric review of telemedicine interface design for accessibility of monitoring current condition in healthcare services

S¹,

Setyonugroho²

2023

World J. Adv. Res. Rev.

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Distance plays a significant role in the utilization of telemedicine, which uses digital communication technologies in healthcare. Medical professionals can remotely monitor, assess, diagnose, and treat patients using information and telecommunications technologies. Another element that helps people utilize telemedicine services is developing an intuitive application display design. Selection series through 1688 publications and 608 publications in the Scopus Database that satisfy the required criteria (publications from 2012 to 2023 using keywords: "telemedicine" AND "interface" AND "design" AND "monitoring" AND "elderly" and in medically linked fields of research). VOSViewer was used to evaluate the data and create 4 full clusters. The majority of the studies took place in America. Wearable technology in patients undergoing medical rehabilitation is the topic of the most cited article. The primary issues of the article are explained together with the cluster themes evaluated, such as: telemedicine interface design and remote patient monitoring. It is necessary to conduct additional research using a comparable methodology to further develop fresh concepts for enhancing the caliber of healthcare services.

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Cost saving analysis of specialized, eHealth-based management of patients receiving oral anticoagulation therapy: Results from the thrombEVAL study

Cited by 5 publications

References 32 publications

Telemedicine-Based Management of Oral Anticoagulation Therapy: Systematic Review and Meta-analysis

Telemedicine-Based Management of Oral Anticoagulation Therapy: Systematic Review and Meta-analysis

Evolving technology: the TRIFLO tri-leaflet mechanical valve without oral anticoagulation: a potential major innovation in valve surgery

Bibliometric review of telemedicine interface design for accessibility of monitoring current condition in healthcare services

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