Published evidence on the success of telecardiology: a mixed record.

We carried out a systematic review of the literature on telecardiology assessment from 1992 to September 2003. We selected articles reporting clinical, economic or administrative outcomes. Quality of evidence was assessed using an approach that considered both study design and study performance. Forty-four studies met the selection criteria. Studies of home care applications, particularly management of congestive heart failure, were of highest quality, giving a high degree of confidence in their findings. Studies on paediatric and non-emergency adult hospital applications were of poorer quality; they were mostly reports of case series and gave relatively little detail. Economic analysis was limited to cost studies and in most cases was judged to be of poor to fair quality. While telecardiology has been widely applied, there is still limited good-quality evidence of its benefits to health-care. Success in establishing the feasibility of telecardiology applications is offset by a failure to obtain convincing data on their influence on health outcomes and on their cost-effectiveness.