The impact of telemedicine strategies on major cardiovascular events in post-acute coronary syndrome: a systematic review and meta-analysis

Abstract Background Digital health interventions have been increasingly used to improve patient outcomes, especially after acute coronary syndrome (ACS). However, their effectiveness in lowering cardiovascular events and enhancing long-term outcomes in ACS patients remains unclear. Purpose We aimed to evaluate the effectiveness of telemedicine strategies in reducing all-cause mortality, rehospitalization, recurrent myocardial infarction (MI), and stroke among patients recently discharged after experiencing ACS. Methods A systematic review and network meta-analysis were conducted following the guidelines of the Cochrane Collaboration and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We included only randomized clinical trials (RCTs) published between January 2000 and December 2024, sourced from PubMed and Embase. Eligible studies compared telemedicine interventions with usual care in patients who had been recently discharged after ACS and had follow-up periods of less than 12 months. Two reviewers independently conducted study selection, data extraction, and risk-of-bias assessments using the Cochrane Risk of Bias 2.0 tool. Data synthesis was performed using a random-effects meta-analysis, reporting risk ratios (RR) or hazard ratios (HR) with 95% confidence intervals (CI). This review is registered with PROSPERO. Results We included 11 randomized controlled trials (RCTs) involving 2,326 patients. The findings indicated that digital health interventions significantly reduced the risk of rehospitalization, with an odds ratio of 0.57 (95% confidence interval: 0.37–0.86). There were no significant differences observed between groups concerning all-cause mortality, recurrent myocardial infarction (MI), or stroke. The heterogeneity of the results was moderate, with an I² value of 39.9%, and the overall quality of the studies ranged from moderate to high. Among the different intervention modalities, telemonitoring demonstrated the greatest impact on rehospitalization rates, with an odds ratio of 0.44 (95% confidence interval: 0.26–0.73), compared to adherence-enhancing strategies and remote cardiac rehabilitation. Conclusion Telemedicine strategies, especially telemonitoring, are effective in reducing rehospitalization rates for patients who have experienced ACS during short-term follow-ups. While no significant differences were found in all-cause mortality, recurrent myocardial infarction (MI), or stroke, it is essential to conduct more high-quality trials to confirm these results and evaluate the long-term effects on cardiovascular events.