Non-invasive telemonitoring programs for patients with chronic heart failure: A systematic review and meta-analysis of randomized controlled trials

Abstract

Aims: To assess whether telemonitoring improves outcomes in patients with chronic heart failure.

Methods and results: A literature search was conducted on studies of randomized controlled trials involving non-invasive telemonitoring and heart failure using Medline, Embase, and Cochrane Library. The primary outcomes were all-cause mortality, all-cause hospitalization, and hospitalization for heart failure. Secondary outcomes were length of stay, health-related quality of life as assessed by validated questionnaires, healthcare costs and cost-effectiveness, and self-care behaviors. We performed a meta-analysis using a random effects model for the primary outcomes. The effect measure was odds ratio with corresponding 95% confidence interval, and heterogeneity among studies was assessed using the Higgins I² value. We screened 212 references, and 34 randomized controlled trials were included in this review. A total of 16179 participants with heart failure were included. Non-invasive telemonitoring reduced all-cause mortality by 18% (OR 0.82, 95% CI 0.71 to 0.95; participants = 15,211; studies = 28; I² = 34%; GRADE: moderate-quality evidence) and heart failure hospitalization by 20% (OR 0.80, 95% CI 0.69 to 0.94; participants = 7491; studies = 18; I² = 31%; GRADE: moderate-quality evidence). Non-invasive telemonitoring didn't demonstrate significant benefit on all-cause hospitalization (OR 0.93, 95% CI 0.82 to 1.05; participants = 11,565; studies = 25; I² = 49%).

Conclusion: Telemonitoring programs in patients with heart failure were associated with a reduction in all-cause mortality and heart failure hospitalization without harmful events.

Keywords: Heart failure; meta-analysis‌; systematic review; telecare; telehealth; telemetry; telemonitoring.