Remote Patient Monitoring and Machine Learning in Acute Exacerbations of Chronic Obstructive Pulmonary Disease: Dual Systematic Literature Review and Narrative Synthesis

Abstract

Background: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are associated with high mortality, morbidity, and poor quality of life and constitute a substantial burden to patients and health care systems. New approaches to prevent or reduce the severity of AECOPD are urgently needed. Internationally, this has prompted increased interest in the potential of remote patient monitoring (RPM) and digital medicine. RPM refers to the direct transmission of patient-reported outcomes, physiological, and functional data, including heart rate, weight, blood pressure, oxygen saturation, physical activity, and lung function (spirometry), directly to health care professionals through automation, web-based data entry, or phone-based data entry. Machine learning has the potential to enhance RPM in chronic obstructive pulmonary disease by increasing the accuracy and precision of AECOPD prediction systems.

Objective: This study aimed to conduct a dual systematic review. The first review focuses on randomized controlled trials where RPM was used as an intervention to treat or improve AECOPD. The second review examines studies that combined machine learning with RPM to predict AECOPD. We review the evidence and concepts behind RPM and machine learning and discuss the strengths, limitations, and clinical use of available systems. We have generated a list of recommendations needed to deliver patient and health care system benefits.

Methods: A comprehensive search strategy, encompassing the Scopus and Web of Science databases, was used to identify relevant studies. A total of 2 independent reviewers (HMGG and CM) conducted study selection, data extraction, and quality assessment, with discrepancies resolved through consensus. Data synthesis involved evidence assessment using a Critical Appraisal Skills Programme checklist and a narrative synthesis. Reporting followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines.

Results: These narrative syntheses suggest that 57% (16/28) of the randomized controlled trials for RPM interventions fail to achieve the required level of evidence for better outcomes in AECOPD. However, the integration of machine learning into RPM demonstrates promise for increasing the predictive accuracy of AECOPD and, therefore, early intervention.

Conclusions: This review suggests a transition toward the integration of machine learning into RPM for predicting AECOPD. We discuss particular RPM indices that have the potential to improve AECOPD prediction and highlight research gaps concerning patient factors and the maintained adoption of RPM. Furthermore, we emphasize the importance of a more comprehensive examination of patient and health care burdens associated with RPM, along with the development of practical solutions.

Keywords: COPD; RPM; acute exacerbations of COPD; chronic obstructive pulmonary disease; exacerbate; exacerbation; exacerbations; literature review; literature reviews; lung; lungs; machine learning; monitoring; narrative review; narrative reviews; predict; prediction; predictions; predictive; pulmonary; remote; remote patient monitoring; respiratory; review methodology; review methods; synthesis.

Figure 1

Distribution of remote patient monitoring indices and average study duration for the first search. The figure illustrates the percentage of total studies each remote patient monitoring index appears in, alongside the average duration of these studies. ECG: electrocardiogram; SpO₂: oxygen saturation.

Figure 2

Distribution of remote patient monitoring indices and average study duration for the second search. The figure illustrates the percentage of total studies each remote patient monitoring index appears in, alongside the average duration of these studies. ECG: electrocardiogram; SpO₂: oxygen saturation.

Figure 3

Rankings of RCTs on remote patient monitoring in chronic obstructive pulmonary disease according to the Critical Appraisal Skills Programme RCT checklist. RCT: randomized controlled trial.

Figure 4

PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram for the search procedure for randomized controlled trials where remote patient monitoring was used as an intervention to treat or improve acute exacerbations of chronic obstructive pulmonary disease.

Figure 5

PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram for the search procedure for empirical studies on remote patient monitoring and machine learning to predict acute exacerbations of chronic obstructive pulmonary disease.