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
ARTICLE HIGHLIGHTS
Research background

Home telemonitoring has been used as a modality to prevent readmission and improve outcomes for patients with heart failure.

Research motivation

However, while telemonitoring was beneficial in reducing hospital admission, all-cause mortality, and emergency room visits in some studies, others did not show such benefits. These differences in outcomes from multiple studies suggest that a careful analysis of study outcomes is needed to determine its aggregate benefit to heart failure patients.

Research objectives

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.

Research methods

We conducted a systematic review and meta-analysis of 38 home telemonitoring randomized controlled trials involving 14993 patients.

Research results

Home telemonitoring in heart failure patients was associated with reduced cardiovascular [relative risk (RR) = 0.66, 95% confidence interval (CI): 0.54-0.81, P < 0.001] and all-cause mortality (RR = 0.83, 95%CI: 0.75-0.92, P = 0.001). Furthermore, telemonitoring was associated with decreased all-cause hospitalization (RR = 0.87, 95%CI: 0.80-0.94, P = 0.002) but not heart failure-related hospitalization (RR = 0.88, 95%CI: 0.77-1.01, P = 0.066). Interestingly, 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.

Research conclusions

Home telemonitoring reduces all-cause and cardiovascular mortality in heart failure patients. This study found that 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.

Research perspectives

The opportunities for future research include a cost-benefit analysis of home telemonitoring in heart failure patients. There is also a need for more studies on the effect of telemonitoring on frequently hospitalized heart failure patients.