Background
　　Telehealth program is a growing field for the care of patients. The evolution of information technology has resulted in telehealth becoming a fourth generation synchronous program. The long-term outcome and the cost-effectiveness analysis of a fourth generation telehealth program have not been reported in patients with chronic cardiovascular diseases.
Objectives
　　We conducted this study to assess the clinical outcomes and cost-effectiveness of a fourth generation, synchronous telehealth program for patients with chronic cardiovascular diseases.
Methods
　　We retrospectively analyzed 575 patients who had joined a telehealth program and compared them with 1178 patients matched for sex, age and Charlson comorbidity index. The program included: (1) instant transmission of biometric data; (2) daily telephone interview; and (3) continuous decision-making support. Data on hospitalization, emergency department (ED) visits and medical costs were collected from the hospital’s database, and were adjusted to the follow-up months.
Results
　　The mean age was 64.5 years. The numbers of monthly ED visits (0.06 vs. 0.09, p<.001), hospitalizations (0.05 vs. 0.11, p<.001), length of hospitalization (days, 0.77 vs. 1.4, p<.001) and intensive care unit admissions (0.01 vs 0.036, p<.001) were lower in the telehealth group. The monthly costs of ED visits (US$20.9 vs US$37.3, p<.001), hospitalizations (US$386.3 vs US$878.2, p<.001) and all medical costs (US$587.6 vs US$1163.6, p<.001) were lower in the telehealth group. The intervention costs were US$224.8 per month. Multivariate analyses revealed that age, telehealth care and Charlson index were the independent factors for ED visits, hospitalizations and length of hospitalization. A bootstrap method revealed the dominant cost-effectiveness of telehealth care over usual care.
Conclusions
　　Better cost-effectiveness and clinical outcomes were noted with the use of a fourth generation synchronous telehealth program in patients with chronic cardiovascular diseases. The intervention costs of this new generation of telehealth program do not increased the total costs for patient care.