Digital technology–enabled healthcare services and cardiovascular outcomes in patients with cardiovascular disease: a systematic review and meta-analysis

Abstract

Abstract Digital technology-enabled healthcare services may support secondary prevention in patients with cardiovascular disease; however, their effects on clinical outcomes remain uncertain. We performed a systematic review and meta-analysis to evaluate their impact on cardiovascular outcomes. PubMed and Embase were searched from inception to 11 March 2025. Randomized controlled trials evaluating digital technology-enabled healthcare services in patients with established cardiovascular disease were included. The primary outcome was major adverse cardiovascular and cerebrovascular events (MACCE), as defined in each trial. Secondary outcomes included rehospitalization, coronary artery disease–related events, all-cause mortality, cardiovascular mortality, revascularization, and adverse events. The protocol was registered in PROSPERO (CRD420251186138) Among 3603 records identified, 14 randomized controlled trials were included. Digital technology-enabled healthcare services were associated with a reduced risk of MACCE (risk ratio 0.595; 95% confidence interval 0.471–0.752; I2 = 0%). Rehospitalization (risk ratio 0.676; 95% confidence interval 0.496–0.923; I2 = 73.9%) and coronary artery disease-related events (risk ratio 0.594; 95% confidence interval 0.354–0.996; I2 = 0%) were also reduced. There were no significant differences in all-cause mortality, cardiovascular mortality, or revascularization (all I2 = 0%). No significant difference in adverse events was observed between groups (I2 = 45.9%). Digital technology-enabled healthcare services were associated with a lower risk of cardiovascular events in patients with established cardiovascular disease. However, substantial heterogeneity was observed for rehospitalization, and no significant reductions were observed in mortality outcomes. Registration PROSPERO identifier: CRD420251186138