Systematic Reviews
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Dec 26, 2022; 14(12): 640-656
Published online Dec 26, 2022. doi: 10.4330/wjc.v14.i12.640
Telemonitoring in heart failure patients: Systematic review and meta-analysis of randomized controlled trials
Chukwuemeka Anthony Umeh, Adrian Torbela, Shipra Saigal, Harpreet Kaur, Shadi Kazourra, Rahul Gupta, Shivang Shah
Chukwuemeka Anthony Umeh, Adrian Torbela, Shipra Saigal, Harpreet Kaur, Shadi Kazourra, Rahul Gupta, Internal Medicine, Hemet Global Medical Center, Hemet, CA 92543, United States
Shivang Shah, Department of Cardiology, Loma Linda University School of Medicine, Loma Linda, CA 92350, United States
Shivang Shah, Department of Cardiology, University of California Riverside School of Medicine, Riverside, CA 92507, United States
Author contributions: Umeh CA, Torbela A, Saigal S, Kaur H, Kazourra S, Gupta R, and Shah S conceptualized and revised the study design; Umeh CA, Torbela A, Saigal S, Kaur H, and Kazourra S extracted the data; Umeh CA analyzed the data; Umeh CA, Torbela A, Saigal S, Kaur H, and Kazourra S wrote the first draft of the paper; Gupta R and Shah S reviewed and revised the paper; and all authors have read and approved the final manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Chukwuemeka Anthony Umeh, MD, Attending Doctor, Internal Medicine, Hemet Global Medical Center, 1117 E Devonshire Ave, Hemet, CA 92543, United States. emmyumeh@gmail.com
Received: August 28, 2022
Peer-review started: August 28, 2022
First decision: October 24, 2022
Revised: November 2, 2022
Accepted: November 30, 2022
Article in press: November 30, 2022
Published online: December 26, 2022
Processing time: 113 Days and 7.7 Hours
Abstract
BACKGROUND

Home telemonitoring has been used as a modality to prevent readmission and improve outcomes for patients with heart failure. However, studies have produced conflicting outcomes over the years.

AIM

To determine the aggregate effect of telemonitoring on all-cause mortality, heart failure-related mortality, all-cause hospitalization, and heart failure-related hospitalization in heart failure patients.

METHODS

We conducted a systematic review and meta-analysis of 38 home telemonitoring randomized controlled trials involving 14993 patients. We also conducted a sensitivity analysis to examine the effect of telemonitoring duration, recent heart failure hospitalization, and age on telemonitoring outcomes.

RESULTS

Our study demonstrated that home telemonitoring in heart failure patients was associated with reduced all-cause [relative risk (RR) = 0.83, 95% confidence interval (CI): 0.75-0.92, P = 0.001] and cardiovascular mortality (RR = 0.66, 95%CI: 0.54-0.81, P < 0.001). Additionally, telemonitoring decreased the all-cause hospitalization (RR = 0.87, 95%CI: 0.80-0.94, P = 0.002) but did not decrease heart failure-related hospitalization (RR = 0.88, 95%CI: 0.77-1.01, P = 0.066). However, prolonged home telemonitoring (12 mo or more) was associated with both decreased all-cause and heart failure hospitalization, unlike shorter duration (6 mo or less) telemonitoring.

CONCLUSION

Home telemonitoring using digital/broadband/satellite/wireless or blue-tooth transmission of physiological data reduces all-cause and cardiovascular mortality in heart failure patients. In addition, prolonged telemonitoring (≥ 12 mo) reduces all-cause and heart failure-related hospitalization. The implication for practice is that hospitals considering telemonitoring to reduce heart failure readmission rates may need to plan for prolonged telemonitoring to see the effect they are looking for.

Keywords: Telemonitoring, Heart failure, Telehealth, Home monitoring, Remote monitoring

Core Tip: Home telemonitoring has been used as a modality to prevent readmission and improve outcomes for patients with heart failure. However, studies have produced conflicting outcomes over the years. This meta-analysis aims to determine the aggregate effect of telemonitoring on all-cause mortality, heart failure-related mortality, all-cause hospitalization, and heart failure-related hospitalization in heart failure patients. This study found that home telemonitoring using digital/broadband/satellite/wireless or blue-tooth transmission of physiological data reduces all-cause and cardiovascular mortality in heart failure patients. Additionally, prolonged home telemonitoring (12 mo or more) led to both decreased all-cause and heart failure hospitalization, unlike shorter duration (6 mo or less) telemonitoring. The implication for practice is that hospitals considering telemonitoring to reduce heart failure readmission rates may need to plan for prolonged telemonitoring to see the effect they are looking for.