Telehealth Use to Address Cardiovascular Disease and Hypertension in the United States: A Systematic Review and Meta-Analysis, 2011–2021

Abstract

Background: The use of telehealth for the management and treatment of hypertension and cardiovascular disease (CVD) has increased across the United States (U.S.), especially during the COVID-19 pandemic. Telehealth has the potential to reduce barriers to accessing health care and improve clinical outcomes. However, implementation, outcomes, and health equity implications related to these strategies are not well understood. The purpose of this review was to identify how telehealth is being used by U.S. health care professionals and health systems to manage hypertension and CVD and to describe the impact these telehealth strategies have on hypertension and CVD outcomes, with a special focus on social determinants of health and health disparities. Methods: This study comprised a narrative review of the literature and meta-analyses. The meta-analyses included articles with intervention and control groups to examine the impact of telehealth interventions on changes to select patient outcomes, including systolic and diastolic blood pressure. A total of 38 U.S.-based interventions were included in the narrative review, with 14 yielding data eligible for the meta-analyses. Results: The telehealth interventions reviewed were used to treat patients with hypertension, heart failure, and stroke, with most interventions employing a team-based care approach. These interventions utilized the expertise of physicians, nurses, pharmacists, and other health care professionals to collaborate on patient decisions and provide direct care. Among the 38 interventions reviewed, 26 interventions utilized remote patient monitoring (RPM) devices mostly for blood pressure monitoring. Half the interventions used a combination of strategies (e.g., videoconferencing and RPM). Patients using telehealth saw significant improvements in clinical outcomes such as blood pressure control, which were comparable to patients receiving in-person care. In contrast, the outcomes related to hospitalizations were mixed. There were also significant decreases in all-cause mortality when compared to usual care. No study explicitly focused on addressing social determinants of health or health disparities through telehealth for hypertension or CVD. Conclusions: Telehealth appears to be comparable to traditional in-person care for managing blood pressure and CVD and may be seen as a complement to existing care options for some patients. Telehealth can also support team-based care delivery and may benefit patients and health care professionals by increasing opportunities for communication, engagement, and monitoring outside a clinical setting.

How Is Telehealth Currently Being Utilized to Help in Hypertension Management within Primary Healthcare Settings? A Scoping Review

“…Our findings show that telehealth is currently being utilized to help manage hypertension in primary healthcare. It also helps to provide remote access to healthcare professionals and enables the monitoring of blood pressure [37,95]. It has been increasingly used during the COVID-19 pandemic to ensure continuity of care and improve access to healthcare services [104].…”

“…Telehealth has shown benefits for hypertension management in primary healthcare. It has the potential to reduce barriers to accessing healthcare and improve clinical outcomes [37]. Telehealth interventions have been used to treat patients with hypertension, heart failure, and stroke, with most interventions employing a team-based care approach [38].…”

Understanding Mental Health Challenges in Cardiovascular Care

“…The WHO defines telehealth as “the delivery of health care services, where distance is a critical factor, by all health care professionals using information and communication technologies for the exchange of valid information for diagnosis, treatment, and prevention of disease and injuries, research and evaluation, and for the continuing education of health care professionals, all in the interests of advancing the health of individuals and their communities” [ 35 ]. Telehealth is commonly used across the US, particularly amplified during the COVID-19 pandemic [ 36 ]. It has revolutionized healthcare by offering patients consistent access to healthcare professionals without the need for physical travel, which is especially beneficial for those with mobility issues or living in remote areas.…”

Home Blood Pressure Monitoring and Its Association With Blood Pressure Control Among Hypertensive Patients With High Cardiovascular Risk in China

“…[7] Previous systematic reviews and meta-analyses showed that HBPM is relatively convenient and more accessible and acceptable to patients, and exhibits comparable reproducibility and capability of predicting outcomes, thereby presenting great potential for increasing long-term treatment adherence and stimulating other lifestyle changes. [8][9][10][11][12][13] Clinical trials have indicated the facilitating roles of HBPM, [8][9][10][11][12][13] and key hypertension guidelines also recommend incorporating the use of HBPM as part of clinical practice. [14][15][16][17][18][19] However, despite the promising prospect of HBPM and the increased ownership of HBPM, the effective utilization of HBPM is rather conditional.…”