JMIR Publications

ABSTRACT

Background:

Telemedicine has been associated with better cardiovascular outcomes, but its effects on the regression of mitral regurgitation(MR) and tricuspid regurgitation(TR) remain unknown.

Objective:

To evaluate whether telemedicine could facilitate the regression of MR and TR compared to usual care and whether it was associated with better survival.

Methods:

This retrospective cohort study enrolled consecutive patients with isolated MR or TR of at least moderate severity and with a follow-up transthoracic echocardiograms (TTE) at least 3 months apart from 2010 through 2020, with follow-up through December, 2022. Patients receiving telehealth services for at least two weeks within 90 days of baseline TTE were categorized as the telehealth-group; the remainder constituted the non-telehealth group. Daily biometric data including blood pressure, pulse rate, blood glucose, electrocardiogram, and oxygen saturation, were transmitted to a cloud-based platform for timely monitoring in telemedicine participants. Experienced case managers contacted patients regularly and initiated immediate action for concerning measurements.

Results:

The MR cohorts consisted of 264 patients (mean age, 67 years), including 97 regressors and 74 telehealth-participants. Telehealth participation (HR 2.20; 95% CI 1.35-3.58; P=0.001) was robustly associated with MR regression, which was linked to reverse cardiac remodeling, represented by left ventricular ejection fraction (LVEF), and LV and LA dimensions (all P≤0.02). Determinants of ACD were age, LVEF, percutaneous coronary intervention, and MR-regressors (all P≤0.02). The TR cohort consisted of 245 patients(mean age, 68 years), including 87 regressors and 61 telehealth participants. Telehealth was one of the univariable determinants of TR regression, while beta-blocker use and baseline TR remained strong predictors of TR regression in multivariable analysis (both P≤0.048).

Conclusions:

Patients in the telehealth group were 2.2 times more likely to experience MR regression. Moreover, MR regressors had better survival and reverse cardiac remodeling compared to non-regressors. These findings may have important implications for future guidelines.