[Does telemonitoring lead to health and economic benefits in patients with chronic heart failure? - a systematic review]

Abstract

Chronic heart failure is a severe and common disease combined with high costs for the German health care system. Deficiencies in standard therapy and limited financial capacities of the German health care system necessitate new approaches in the care of chronic heart failure patients.The present study aims to analyse the scientific level of knowledge of clinical, economic and other outcomes of telemonitoring compared with standard therapy for patients with chronic heart failure. Results should provide an evidence base for health-care decision makers.To determine the outcomes, a systematic review was carried out by using the database MEDLINE. In accordance with defined inclusion and exclusion criteria, 10 randomized controlled trials remained. Furthermore, 4 studies of a hand research and the recently published results of one of the largest national studies were included.As a result of the systematic review, there is currently no evidence for the benefits of telemonitoring compared with standard therapy. National studies identified significant improvements or a tendency for improvements in terms of quality of life and costs/cost-effectiveness as well as partly in mortality, hospital duration and medication adherence. International studies diverged in their results. The comparability and validity of the investigated studies are limited due to a low number of national studies, different settings of the telemonitoring programmes, the inclusion of different NYHA classes, the heterogeneity of study endpoints and endpoint-related causes, short observation periods of some studies as well as questionable transferability of international cost-results to the German health care system. Furthermore, differences in standard therapy between national and international studies were identified. None of the international studies performed a comparison between clinical and economic outcomes.With regard to the future prospects of telemonitoring in Germany there is still a need for further high quality studies (particularly on the national level) concerning the clinical, economic and other outcomes of telemonitoring compared with standard therapy. Clear evidence is a sine qua non for telemonitoring's inclusion in the benefits catalogue of the statutory health insurance. For a better comparability of studies, standardised telemonitoring programmes and study criteria should be developed and applied.