Telehealth and telemedicine, if properly used, may offer advantages for both patients and health professionals. As per the World Health Organization (WHO), telemedicine can be defined as “the delivery of medical services, where distance is a basic factor, by all medical care experts utilizing information and communication technologies (ICT) for the exchanging of adequate information for the treatment, diagnosis and avoidance of illness and wounds, exploration and assessment, and for the proceeding with instruction of medical care suppliers, in the purpose of strengthening individuals health and their networks”. Telemedicine includes the protected transmission of clinical information and data, by voice, text, images, or other forms required for the diagnosis, treatment, and patient follow up.
In recent years, there has been a growing interest in the development of precision medicine approaches in the prevention and treatment of several pathologies with the purpose to offer to patients “the right treatment, to the right patient, at the right time”. In cardiovascular medicine, the potential of precision medicine applies to all stages of disease development and includes risk prediction, preventative measures, and targeted therapeutic approaches . Telehealth and telemedicine enable precision medicine by two routes following data review by a doctor. These include a direct (online) discussion between a patient and doctor regarding a therapy (e.g., change dosing, prescription renewal) and prescriptions to the patient for them to undergo more precise testing and assessment. In both cases, the online session may add information or data to the patient history.
Telehealth and telemedicine, if properly used, may offer advantages for both patients and health professionals . As per the World Health Organization (WHO), telemedicine can be defined as “the delivery of medical services, where distance is a basic factor, by all medical care experts utilizing information and communication technologies (ICT) for the exchanging of adequate information for the treatment, diagnosis and avoidance of illness and wounds, exploration and assessment, and for the proceeding with instruction of medical care suppliers, in the purpose of strengthening individuals health and their networks” . Telemedicine includes the protected transmission of clinical information and data, by voice, text, images, or other forms required for the diagnosis, treatment, and patient follow up.
The telemedicine field applied to CVD is defined as telecardiology . Personal medications or treatment can be suggested over video or phone conversations with the pill dispenser at hand. Family members or friends (from different locations) can participate in these visits and understand expert suggestions for improving the health literacy of the entire family. On the other hand, patients can remain at home with comfort, which allows welcoming talks with more involvement in decision making about their cardiac health, e.g., monitoring of blood pressure by taking acute readings with home devices. Frequent telemedicine visits can allow doctors to encourage patients to perform BP checkups. Studies have shown that self-observation improves both BP estimations and medicine adherence [11,12]. Moreover, hypertension is also an ongoing illness that stands at risk of CVDs and benefits largely from successive telehealth visits.
In this study, we conducted a systematic review analysis to explore the importance of telemedicine services in the provision of personalized care for CVDs. Moreover, we reviewed telecardiology advancements in the last decade and how the world is adopting telemedicine support in daily cardiologic practice.
Initially, we collected the available literature from high-quality medical libraries such as PubMed (MEDLINE) and the Cumulative Index to Nursing and Allied Health Literature (CINAHL). The Scopus (EMBASE) database was used for sorting out non-appearance articles from the two medical libraries. Medical Subject Headings (MeSH) were applied to identify key terms of MEDLINE. Under the ‘cardiovascular diseases and ‘telemedicine’ key terms, we were able to identify 63 and 11 subheadings, respectively, with the help of the MeSH list. The search string with the Boolean operator as ‘telemedicine’ AND ‘cardiovascular diseases’ for PubMed was used. For CINAHL, we included similar MeSH terms to those used in MEDLINE and, for Scopus (EMBASE), Boolean operators such as ‘telemedicine’ OR ‘telehealth’ OR ‘telecardiology’ AND ‘adoption’ OR ‘implementation’ AND ‘personalized care’ OR ‘personal medication’ OR ‘personal care’ AND ‘cardiovascular diseases OR ‘CVD’ OR ‘cardiology’ were applied.
Articles on telemedicine or telehealth in providing personal care for patients with a high risk of CVDs were considered for this research. Articles from peer-reviewed journals, featuring descriptive work in the English language with full text, implementing cross-sectional and mixed methods (including quantitative and qualitative), with telemedicine objectives in cardiovascular care, were included. Exclusion criteria were (a) conference works, (b) abstract-only articles, and (c) articles published before 2011. Studies with irrelevant data on telemedicine and that did not mention telecardiology involvement were excluded from the study.
Once the literature search was done, the four authors independently assessed every article in two phases. In the first phase, duplicated or similar papers extracted from the three databases were removed by reading abstracts. This analysis was conducted by the conventional approach of reading the article title and abstract. After applying inclusion and exclusion criteria, the quality evolution of each selected item was done based on the Newcastle–Ottawa Scale (NOS) that ranged from 0–9 . The NOS defined each study in three ways as poor (0–4), moderate (5–6), and good (7–9). These scores were based on some filters such as study selection, comparability, and outcome. Various quality parameters such as demonstration, coherence, risk factors, and others were also considered. The quality scores of selected articles calculated using the above parameters were recorded in an excel sheet to calculate whether a selected study was suitable for final consideration or not.
All 19 studies considered suitable for our analysis were conducted in developed nations. This suggests that telemedicine technologies in CVD prevention are more ready to be adopted in developed areas. Considering cost constraints in telemedicine implementation, governments or private bodies should provide financial support. A high number of studies (15/19, 78.94%) were funded by external organizations including public (11/15, 73.3%) and private bodies (4/15, 26.7%) (Refer Table 1 ).
Some medical hospitals launched telemedicine via 4G tablets to provide chronic care including CVD and chronic heart failure. Patients are equipped with Bluetooth biometric devices (e.g., pulse oximeter) to measure blood pressure, oxygen levels, weight, and temperature . These devices automatically record and transmit data that can be used for improved home care monitoring. Remote monitoring of implanted devices is usually associated with the transmission of recorded data via an external transmitter to the provided database. The patient data are transmitted daily. This can improve clinical outcomes , enhance patient satisfaction , and save patient data.
Coronary heart failure is a major risk factor for CVD. A randomized controlled trial (RCT) among 223 patients (mean age = 56.4 ± 9.0) with CHD assigned into two groups, Cardio Fit ( n = 115, mean age = 56.7 ± 9.0) and usual care ( n = 108, mean age = 56.0 ± 9.0), was carried out to assess the effects of online coaching on physical activity intervention for CHD patients by comparing usual care over 1 year . The Cardio Fit group received a personally tailored physical activity regimen and access to a secure website for activity planning and tracking. Online training was also given to the Cardio Fit group, and they were in email contact with an exercise specialist. In contrast, the usual care group received physical activity guidance from their cardiologist. The authors found that at the two-time points (every 6 months), the Cardio Fit group took an average of 764 (12% absolute difference) more steps per day than the usual care group. Furthermore, it was shown that patients with heart failure can be discharged from the hospital to evaluate medication adherence via telephone .
Telemonitoring reduces the readmission of patients with heart failure and significantly decreases contact with specialized nurses on this matter . Some studies highlighted that telemedicine and telemonitoring applications have the potential to transmit diagnostic images, data, or reports, virtually connecting the patients and health professional in the screening of CVD; telemedicine via telephone communication is particularly useful in the early detection of CVDs, thus reducing costs [27,28,29]. The study by Koehler et al.  randomized 1571 patients with heart failure to assess the effect of remote patient management intervention on unplanned cardiovascular admission and mortality. The authors randomly assigned the patients into two groups to receive remote patient management ( n = 796) or usual care ( n = 775). The percentage of days lost due to unplanned cardiovascular hospital admission or death from all causes was significantly reduced in patients allocated to remote patient management (ratio: 0.80; 95% CI: 0.60–1.00, p-value = 0.0460) when compared to usual care . In this regard, supporting telemedicine interventions in patients with heart failure can reduce unplanned cardiovascular hospitalizations and all causes of mortality.
The overall findings of this work highlight the importance of telemedicine and telehealth technologies in the management of personal care among CVD patients. Moreover, they provide evidence of the benefits of cardiovascular care when using telemedicine in developed nations. Many studies are available on telemedicine applications, but sophisticated qualified studies are still very few, and the generalization of most evaluation outcomes is rather limited. However, one positive finding is that the world is now understanding the importance of these technologies because of significant challenges introduced by COVID-19. There has at least been a start in some developing countries, with public bodies ready to improve the economic situation through the adoption of telemedicine. We strongly suggest future developments for the provision of medical services through telemedicine, along with necessary training for both patients and providers, thus resulting in better healthcare and enhanced patient satisfaction.