A Meta-Analysis of eHealth Interventions on Ischaemic Heart Disease Health Outcomes

Puteri Sofia Nadira Megat Kamaruddin; Azmawati Mohammed Nawi; Mohd Rizal Abdul Manaf; Mohamad Nurman Yaman; Abdul Muizz Abd Malek

doi:10.5334/gh.1173

A Meta-Analysis of eHealth Interventions on Ischaemic Heart Disease Health Outcomes

Glob Heart. 2023 Mar 16;18(1):12. doi: 10.5334/gh.1173. eCollection 2023.

Authors

Puteri Sofia Nadira Megat Kamaruddin¹, Azmawati Mohammed Nawi¹, Mohd Rizal Abdul Manaf¹, Mohamad Nurman Yaman², Abdul Muizz Abd Malek³

Affiliations

¹ Department of Community Health, Universiti Kebangsaan Malaysia, Kuala Lumpur, MY.
² Department of Medical Education, Universiti Kebangsaan Malaysia, Kuala Lumpur, MY.
³ Cardiology Department, Hospital Serdang, Kajang, MY.

Abstract

Background: Electronic Health (eHealth) interventions as a secondary prevention tool to empower patients' health in decision-making and behaviour.

Objective: With the growing body of evidence supporting the use of eHealth interventions, the intention is to conduct a meta-analysis on various health outcomes of eHealth interventions among ischaemic heart disease (IHD) patients.

Methods: Based on PRISMA guidelines, eligible studies were searched through databases of Web of Science, Scopus, PubMed, EBSCOHost, and SAGE (PROSPERO registration CRD42021290091). Inclusion criteria were English language and randomised controlled trials published between 2011 to 2021 exploring health outcomes that empower IHD patients with eHealth interventions. RevMan 5.4 was utilised for meta-analysis, sensitivity analysis, and risk of bias (RoB) assessment while GRADE software for generating findings of physical health outcomes. Non-physical health outcomes were analysed using SWiM (synthesis without meta-analysis) method.

Results: This review included 10 studies, whereby, six studies with 895 participants' data were pooled for physical health outcomes. Overall, the RoB varied significantly across domains, with the majority was low risks, a substantial proportion of high risks and a sizeable proportion of unclear. With GRADE evidence of moderate to high quality, eHealth interventions improved low density lipoprotien (LDL) levels in IHD patients when compared to usual care after 12 months of interventions (SMD -0.26, 95% CI [-0.45, -0.06], I² = 0%, p = 0.01). Significance appraisal in each domain of the non-physical health outcomes found significant findings for medication adherence, physical activity and dietary behaviour, while half of the non-significant findings were found for other behavioural outcomes, psychological and quality of life.

Conclusions: Electronic Health interventions are found effective at lowering LDL cholesterol in long-term but benefits remain inconclusive for other physical and non-physical health outcomes for IHD patients. Integrating sustainable patient empowerment strategies with the advancement of eHealth interventions by utilising appropriate frameworks is recommended for future research.

Keywords: LDL; eHealth intervention; ischaemic heart disease; meta-analysis.

Publication types

Meta-Analysis
Review
Research Support, Non-U.S. Gov't

MeSH terms

Coronary Artery Disease*
Humans
Medication Adherence
Myocardial Ischemia* / epidemiology
Myocardial Ischemia* / prevention & control
Outcome Assessment, Health Care
Quality of Life
Telemedicine*