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Meta-Analysis
. 2020 Nov 13;22(11):e20032.
doi: 10.2196/20032.

Effects of Different Telemonitoring Strategies on Chronic Heart Failure Care: Systematic Review and Subgroup Meta-Analysis

Hang Ding #  1   2   3 , Sheau Huey Chen #  4 , Iain Edwards  5 , Rajiv Jayasena  6 , James Doecke  6 , Jamie Layland  7   8 , Ian A Yang  9 , Andrew Maiorana  4   10
Affiliations
Meta-Analysis

Effects of Different Telemonitoring Strategies on Chronic Heart Failure Care: Systematic Review and Subgroup Meta-Analysis

Hang Ding et al. J Med Internet Res. .

Abstract

Background: Telemonitoring studies in chronic heart failure are characterized by mixed mortality and hospitalization outcomes, which have deterred the uptake of telemonitoring in clinical practice. These mixed outcomes may reflect the diverse range of patient management strategies incorporated in telemonitoring. To address this, we compared the effects of different telemonitoring strategies on clinical outcomes.

Objective: The aim of this systematic review and subgroup meta-analysis was to identify noninvasive telemonitoring strategies attributing to improvements in all-cause mortality or hospitalization outcomes for patients with chronic heart failure.

Methods: We reviewed and analyzed telemonitoring strategies from randomized controlled trials (RCTs) comparing telemonitoring intervention with usual care. For each strategy, we examined whether RCTs that applied the strategy in the telemonitoring intervention (subgroup 1) resulted in a significantly lower risk ratio (RR) of all-cause mortality or incidence rate ratio (IRR) of all-cause hospitalization compared with RCTs that did not apply this strategy (subgroup 2).

Results: We included 26 RCTs (N=11,450) incorporating 18 different telemonitoring strategies. RCTs that provided medication support were found to be associated with a significantly lower IRR value than RCTs that did not provide this type of support (P=.01; subgroup 1 IRR=0.83, 95% CI 0.72-0.95 vs subgroup 2 IRR=1.02, 95% CI 0.93-1.12). RCTs that applied mobile health were associated with a significantly lower IRR (P=.03; IRR=0.79, 95% CI 0.64-0.96 vs IRR=1.00, 95% CI 0.94-1.06) and RR (P=.01; RR=0.67, 95% CI 0.53-0.85 vs RR=0.95, 95% CI 0.84-1.07).

Conclusions: Telemonitoring strategies involving medication support and mobile health were associated with improvements in all-cause mortality or hospitalization outcomes. These strategies should be prioritized in telemonitoring interventions for the management of patients with chronic heart failure.

Keywords: chronic heart failure; meta-analysis; mobile health; systematic review; telehealth; telemonitoring.

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Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
Flow diagram of study selection.
Figure 2
Figure 2
Risk of bias assessment. Authors' judgments about each methodological quality item are presented as percentages across all included studies.
Figure 3
Figure 3
Risk of bias summary. Authors' judgements about each risk of bias item are summarized for each included study.
Figure 4
Figure 4
Event counts and effectiveness of telemonitoring interventions on all-cause mortality. There were 20 randomized controlled trials (N=10,263) with mortality event counts in the subgroup meta-analysis. RR: relative risk.
Figure 5
Figure 5
Event counts and effectiveness of telemonitoring interventions on all-cause hospitalization. There were 24 randomized controlled trials (N=9612) with hospitalization event counts in the subgroup meta-analysis. IRR: incidence rate ratio.
See this image and copyright information in PMC

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