Background:
The COVID-19 pandemic’s contagion has forced healthcare to use telehealth. Evidence shows significant risks of telehealth use and potential issues that could compromise patient safety and decrease quality of care. This study aims to systematically review telehealth interventions assessed by randomized controlled trials (RCTs) and their effects.

Methods:
We searched for randomized controlled trials of interventions to patients that received any type of telehealth tool as an intervention and compared it with a control group that also reported outcomes. We searched for PRISMA guideline English-language studies published until March 2021 in multiple databases including PubMed, Embase, and Scopus. Studies were categorized according to methodological quality, sample size, intervention characteristics, outcome, statistical significance, and direction of effects. A meta-analysis of sufficiently homogenous studies was conducted after quality assessment and data extraction.

Results:
Of the 5,144 articles identified, 78 were included in the review. 8 were chosen to perform 2 separate meta-analyses (n=4 for each). The first assessed mortality rate in heart failure patients, showing the pooled relative risk of mortality to be 0.60 (95% CI, 0.0999-3.5478), p=0.42. The second assessed mortality in patients with cardiac implants: the pooled relative risk of mortality was 0.65 (95% CI, 0.4389-0.9541), p=0.028. Pooled qualitative assessment of the remaining studies was performed, producing two groups: telerehabilitation and miscellaneous studies.

Conclusions:
The results suggest that monitoring patients using telehealth techniques is associated with 40% lower mortality risk among patients suffering from heart failure or cardiac implants, compared to those who received traditional care methods. Telerehabilitation was observed to be comparable with the conventional rehab methods. Telehealth applications that manage chronic disease resulted in lower or comparable mortality rates and hospitalization/re-admission rates. Cognitive behavioral and online psychotherapy show promise as alternative to conventional methods. Telehealth should be considered a safe alternative to traditional medical procedures.