Telemedicine in patients with peripheral arterial disease: is it worth the effort?

Introduction: For patients with peripheral arterial disease (PAD), the various components of telemedicine, such as telemonitoring, telecoaching, and teleconsultation, could be valuable in daily management. The objective of this review was to give an overview of the current use of telemedicine interventions in PAD. Areas covered: A literature search was performed for studies that evaluated patients with PAD of the aorto-pedal trajectory, who were monitored by telemedicine and acted upon accordingly. The primary outcome was health-related outcomes. The studies that were found focused mainly on wearable activity monitoring and telecoaching in PAD (n = 4) or wound monitoring after vascular surgery (n = 2). Main results indicate that telemedicine interventions are able to detect (post-operative) complications early, improve functional capacity and claudication onset time, and improve PAD patients’ quality of life. Expert opinion: The use of telemedicine in PAD patients is still an under-explored area. Studies investigating the use of telemedicine in PAD are very limited and show varying results. Owing to its high potential in improving physical ability, lifestyle coaching, and timely detection of deterioration, future research should focus on proper implementation of telemedicine in PAD patients, including clinical and feasibility outcomes, effect on workload of nurses, and cost-efficiency.

引言：针对外周动脉疾病（peripheral arterial disease, PAD）患者，远程医疗（telemedicine）的各类组成模块，如远程监测（telemonitoring）、远程辅导（telecoaching）与远程会诊（teleconsultation），在其日常管理中具备重要应用价值。本综述旨在全面概述远程医疗干预在PAD患者中的当前应用现状。
研究覆盖范围：本研究通过文献检索，纳入针对主动脉-足动脉通路型PAD患者、采用远程医疗监测并据此采取相应干预措施的相关研究。本研究的主要结局指标为健康相关结局。纳入的现有研究主要聚焦于PAD患者的可穿戴活动监测与远程辅导（共4项研究），或血管外科术后伤口监测（共2项研究）。主要研究结果显示，远程医疗干预可早期发现（术后）并发症，改善患者的运动功能能力与跛行发作时间，并提升PAD患者的生活质量。
专家观点：远程医疗在PAD患者中的应用仍属于未被充分探索的领域。针对PAD患者远程医疗应用的相关研究极为有限，且研究结果存在异质性。鉴于其在提升患者体能、开展生活方式辅导以及及时发现病情恶化方面具备巨大潜力，未来研究应聚焦于PAD患者远程医疗的规范化落地实施，包括临床与可行性结局指标、对护理人员工作负荷的影响以及成本效益。