Meta-analysis and meta-regression of telehealth programmes for patients with chronic heart failure

Abstract

To assess the effectiveness of telehealth used for chronic heart failure (CHF) patients, we searched for peer-reviewed, randomized controlled trials published between 2001 and 2012. A total of 33 studies met the inclusion criteria. There were 26 studies (79%) which concerned tele-monitoring and 7 (21%) which concerned case management or nurse administered telephone-based management. There were 7530 patients in all, with an average age of 69 years. A meta-analysis showed that telehealth programmes had significant overall effectiveness in reducing all-cause mortality (Fixed effect model risk ratio 0.76, 95% CI 0.66 to 0.88), CHF-related hospitalization (Random effect model risk ratio 0.72, 95% CI 0.61 to 0.85) and CHF-related length of stay (Random effect model mean difference -1.41 days, 95% CI -2.43 to -0.39). In addition, telehealth programmes showed significantly greater effectiveness in reducing mortality and hospitalizations among patients with higher New York Heart Association (NYHA) categories. With age and NYHA held constant, recording questionnaire (symptoms) data could reduce the mortality risk by 34% and the risk of CHF-related hospitalization by 15%; adding a pulse (heart rate) detector could reduce the mortality risk by 40% and the risk of CHF-related hospitalization by 43%. Finally, telehealth programmes showed a tapering effect on mortality reduction: the longer the follow-up period, the less effective they were on decreasing mortality. In conclusion, telehealth programmes demonstrated clinical effectiveness in patients with CHF compared with usual care.