ประสิทธิผลของการแพทย์ทางไกลสำหรับการป้องกันแบบทุติยภูมิในผู้ป่วยกลุ่มโรคหัวใจขาดเลือดเฉียบพลัน: การทบทวนวรรณกรรมอย่างเป็นระบบและการวิเคราะห์อภิมาน

Bongkoch Mahakeeta; Waranee Bunchuailua

doi:10.69598/tbps.22.1.15-36

Authors

Bongkoch Mahakeeta Paolo Hospital Phra Pradaeng, Samut Prakan
Waranee Bunchuailua Division of Social and Administrative Pharmacy, Faculty of Pharmacy, Silpakorn University, Sanamchandra Palace Campus, Nakhon Pathom

DOI:

https://doi.org/10.69598/tbps.22.1.15-36

Keywords:

telemedicine, secondary prevention, acute coronary syndrome, systematic review, meta-analysis

Abstract

Continuous risk factor control in patients with acute coronary syndrome (ACS) is essential for reducing recurrent cardiovascular events. Telemedicine has emerged as a promising adjunct for secondary prevention; however, systematic synthesis of empirical evidence remains limited. This study aimed to evaluate the efficacy of telemedicine compared with usual care in controlling cardiovascular risk factors — specifically low-density lipoprotein (LDL) cholesterol, blood pressure, body mass index (BMI), and smoking cessation rates. We conducted a systematic review and meta-analysis of randomized controlled trials retrieved from PubMed, EMBASE, Cochrane, and CINAHL databases. Fourteen trials including 5,436 patients were included. Telemedicine increased the likelihood of achieving LDL levels below 1.8 mmol/L by 11% (RR = 1.11, 95% CI 1.04–1.18) and markedly reduced LDL levels (MD = –0.11 mmol/L, 95% CI –0.22, –0.01). In studies with a low risk of bias, blood pressure was significantly reduced (MD = –5.58 mmHg, 95% CI –10.83, –0.32). A subgroup analysis of Australian studies revealed a notable decrease in BMI (MD = –1.16, 95% CI –1.88, –0.44). No significant effect on smoking cessation was observed. These findings indicate that telemedicine is effective in controlling LDL cholesterol and blood pressure in ACS patients and should be integrated as a component of standard secondary prevention programs.

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