Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2023 Aug 14;44(31):2911-2926.
doi: 10.1093/eurheartj/ehad280.

Telemonitoring for heart failure: a meta-analysis

Niels T B Scholte  1 , Muhammed T Gürgöze  1 , Dilan Aydin  1 , Dominic A M J Theuns  1 , Olivier C Manintveld  1 , Eelko Ronner  2 , Eric Boersma  1 , Rudolf A de Boer  1 , Robert M A van der Boon  1 , Jasper J Brugts  1
Affiliations
Meta-Analysis

Telemonitoring for heart failure: a meta-analysis

Niels T B Scholte et al. Eur Heart J. .

Erratum in

Abstract

Aims: Telemonitoring modalities in heart failure (HF) have been proposed as being essential for future organization and transition of HF care, however, efficacy has not been proven. A comprehensive meta-analysis of studies on home telemonitoring systems (hTMS) in HF and the effect on clinical outcomes are provided.

Methods and results: A systematic literature search was performed in four bibliographic databases, including randomized trials and observational studies that were published during January 1996-July 2022. A random-effects meta-analysis was carried out comparing hTMS with standard of care. All-cause mortality, first HF hospitalization, and total HF hospitalizations were evaluated as study endpoints. Sixty-five non-invasive hTMS studies and 27 invasive hTMS studies enrolled 36 549 HF patients, with a mean follow-up of 11.5 months. In patients using hTMS compared with standard of care, a significant 16% reduction in all-cause mortality was observed [pooled odds ratio (OR): 0.84, 95% confidence interval (CI): 0.77-0.93, I2: 24%], as well as a significant 19% reduction in first HF hospitalization (OR: 0.81, 95% CI 0.74-0.88, I2: 22%) and a 15% reduction in total HF hospitalizations (pooled incidence rate ratio: 0.85, 95% CI 0.76-0.96, I2: 70%).

Conclusion: These results are an advocacy for the use of hTMS in HF patients to reduce all-cause mortality and HF-related hospitalizations. Still, the methods of hTMS remain diverse, so future research should strive to standardize modes of effective hTMS.

Keywords: Heart failure; Hospitalization; Invasive; Mortality; Non-invasive; Telemonitoring.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest: D.T. received research grants from Boston Scientific and Biotronik. O.M. received consulting fees from Abbott, AstraZeneca, and Boehringer-Ingelheim. R.d.B. has received research grants and/or fees from AstraZeneca, Abbott, Boehringer-Ingelheim, Cardior Pharmaceuticals GmbH, Ionis Pharmaceuticals, Inc., Novo Nordisk, and Roche; and has had speaker engagements with Abbott, AstraZeneca, Bayer, Bristol Myers Squibb, Novartis, and Roche. R.v.d.B. received an independent research grant and speaker fee from Abbott. J.B. received independent research grant from Abbott for ISS and has had speaker engagement or advisory boards in the past 5 years with Astra Zeneca, Abbott, Boehringer-Ingelheim, Bayer, Daiichi Sankyo, Novartis and Vifor. All other authors declared to have no conflict of interest.

Figures

Structured Graphical Abstract
Structured Graphical Abstract
Summary results for all-cause mortality, first heart failure hospitalization, and total/recurrent heart failure hospitalizations divided in invasive home telemonitoring systems and non-invasive home telemonitoring systems and total. I2 represents heterogeneity between studies. CI, confidence interval.
Figure 1
Figure 1
Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow-chart.
Figure 2
Figure 2
Forest plot all-cause mortality. TM, telemonitoring; STS, structured telephone support; complex TM, complex telemonitoring; hTMS, home telemonitoring systems; CIED, cardiac implantable electronic devices; IHM, invasive haemodynamic monitoring. *The studies of Mortara et al. and Cleland et al. have multiple intervention arms. Therefore, those articles are presented more than once in the forest plot. In the subtotal non-invasive home telemonitoring systems and the total pooled analysis, event rates of each study arm are added together. **From the article of Lindenfeld et al., the post-COVID analysis was used, to avoid bias in observed outcomes due to the COVID pandemic.
Figure 2
Figure 2
Forest plot all-cause mortality. TM, telemonitoring; STS, structured telephone support; complex TM, complex telemonitoring; hTMS, home telemonitoring systems; CIED, cardiac implantable electronic devices; IHM, invasive haemodynamic monitoring. *The studies of Mortara et al. and Cleland et al. have multiple intervention arms. Therefore, those articles are presented more than once in the forest plot. In the subtotal non-invasive home telemonitoring systems and the total pooled analysis, event rates of each study arm are added together. **From the article of Lindenfeld et al., the post-COVID analysis was used, to avoid bias in observed outcomes due to the COVID pandemic.
Figure 3
Figure 3
Forest plot first hospitalization. TM, telemonitoring; STS, structured telephone support; complex TM, complex telemonitoring; hTMS, home telemonitoring systems; CIED, cardiac implantable electronic devices; IHM, invasive haemodynamic monitoring. *The studies of Mortara et al. and Cleland et al. have multiple intervention arms. Therefore, those articles are presented more than once in the forest plot. In the subtotal non-invasive home telemonitoring systems and the total pooled analysis, event rates of each study arm are added together.
Figure 4
Figure 4
Forest plot total hospitalizations. TM, telemonitoring; STS, structured telephone support; complex TM, complex telemonitoring; hTMS, home telemonitoring systems; CIED, cardiac implantable electronic devices; IHM, invasive haemodynamic monitoring. *The studies of Mortara et al. have multiple intervention arms. Therefore, those articles are presented more than once in the forest plot. In the subtotal non-invasive home telemonitoring systems and the total pooled analysis, event rates of each study arm are added together. **From the article of Lindenfeld et al., the post-COVID analysis was used, to avoid bias in observed outcomes due to the COVID pandemic.
See this image and copyright information in PMC

Comment in

References

    1. McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Bohm M, et al. 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2021;42:3599–3726. 10.1093/eurheartj/ehab368 - DOI - PubMed
    1. Farre N, Vela E, Cleries M, Bustins M, Cainzos-Achirica M, Enjuanes C, et al. Real world heart failure epidemiology and outcome: a population-based analysis of 88,195 patients. PLoS One 2017;12:e0172745. 10.1371/journal.pone.0172745 - DOI - PMC - PubMed
    1. Tersalvi G, Winterton D, Cioffi GM, Ghidini S, Roberto M, Biasco L, et al. Telemedicine in heart failure during COVID-19: a step into the future. Front Cardiovasc Med 2020;7:612818. 10.3389/fcvm.2020.612818 - DOI - PMC - PubMed
    1. Craig J, Patterson V. Introduction to the practice of telemedicine. J Telemed Telecare 2005;11:3–9. 10.1177/1357633X0501100102 - DOI - PubMed
    1. Inglis SC, Clark RA, Dierckx R, Prieto-Merino D, Cleland JG. Structured telephone support or non-invasive telemonitoring for patients with heart failure. Cochrane Database Syst Rev 2015;10:CD007228. - PMC - PubMed

Publication types