Telemonitoring in heart failure patients: Systematic review and meta-analysis of randomized controlled trials

Table 1 Summary of studies included in the meta-analysis

Ref.	Number of patients	Duration of follow-up (mo)	Country	Person responsible for monitoring telemedicine data	Frequency of measuring and transmitting vital signs	Frequency of clinicians reviewing data	Included telemonitoring patients’ education	Included control group patient education	Recruited patients ≥ 65 yr	Recruited recently discharged patients	Recruited frequently hospitalized patients
Nouryan et al[15], 2019	89	6	United States	Nurse	Daily	Daily	Yes	Yes	Yes	No	No
Seto et al[16], 2012	100	6	Canada	Physician	Daily	Daily	No	No	No	No	No
Weintraub et al[17], 2010	188	3	United States	Nurse	Daily	Daily	Yes	Yes	No	Yes	No
Blum and Gottlieb[18], 2014	156	27	United States	Nurse	Daily	Daily	No	No	No	No	No
Dansky et al[19], 2008	284	4	United States	Nurse	Daily	Daily	No	No	No	No	No
Kashem et al[20], 2008	48	12	United States	Nurse	Daily	Daily	No	No	No	No	No
Benatar et al[21], 2003	216	12	United States	Nurse	Daily	Daily	No	Yes	No	Yes	No
Pedone et al[22], 2015	96	6	Italy	Physician	Daily	Daily	No	No	Yes	No	No
Wade et al[23], 2011	316	6	United States	Case manager	Daily	Daily	Yes	Yes	Yes	No	No
Comín-Colet et al[24], 2016	178	6	Spain	Nurse	Daily	Daily	No	No	No	Yes	No
Olivari et al[25], 2018	339	12	Italy	Non-clinician	Daily	Daily	No	No	Yes	No	No
Lyngå et al[26], 2012	319	12	Sweden	Nurse	Daily	3 d a week	No	No	No	No	No
Scherr et al[27], 2009	120	6	Austria	Physician	Daily	Daily	No	No	No	Yes	No
Antonicelli et al[28], 2008	57	12	Italy	Nurse	Weekly	Weekly	Yes	No	Yes	No	No
Giordano et al[29], 2009	460	12	Italy	Nurse	Daily	Daily	Yes	No	No	No	No
Ong et al[30], 2016	1437	6	United States	Nurse	Daily	Daily	Yes	No	No	Yes	No
Kalter-Leibovici et al[10], 2017	1360	32	Isreal	Nurse	Daily	Daily	Yes	No	No	No	No
Mortara et al[31], 2009	461	12	United Kingdom, Poland, and Italy	Nurse	Weekly	Weekly	No	No	No	No	No
Dar et al[32], 2009	182	6	United Kingdom	Nurse	Daily	Daily	No	No	No	Yes	No
Vuorinen et al[33], 2014	94	6	Finland	Nurse	Weekly	Weekly	No	No	No	No	No
Goldberg et al[34], 2003	280	6	United States	Nurse	Daily	Daily	No	No	No	No	No
Soran et al[35], 2008	315	6	United States	Nurse	Daily	Daily	No	No	Yes	No	No
Chaudhry et al[36], 2010	1653	6	United States	Physician	Daily	Daily	No	No	No	Yes	No
Koehler et al[13], 2018	1571	12	Germany	Physician	Daily	Daily	Yes	No	No	No	No
Cleland et al[14], 2005	418	8	Germany, Netherlands, and United Kingdom	Nurse	Daily	Daily	Yes	No	No	Yes	No
Koehler et al[7], 2011	710	26	Germany	Physician	Daily	Daily	No	No	No	No	No
Kotooka et al[8], 2018	181	15	Japan	Nurse	Daily	Daily	No	No	No	Yes	No
Pekmezaris et al[9], 2019	104	3	United States	Nurse	Daily	Daily	Yes	No	No	Yes	No
Villani et al[37], 2014	80	12	Italy	Nurse	Daily	Daily	No	No	Yes	Yes	Yes
Dendale et al[38], 2012	160	6	Belgium	Nurse	Daily	Daily	No	No	No	Yes	No
Woodend et al[39], 2007	121	3	Canada	Nurse	Daily	Daily	Yes	No	No	Yes	No
Galinier et al[40], 2020	937	18	France	Nurse	Daily	Daily	Yes	No	No	No	No
Capomolla et al[41], 2004	133	12	Italy	Nurse	Daily	Daily	Yes	No	No	No	No
Kulshreshtha et al[42], 2010	150	6	United States	Nurse	Daily	Daily	No	No	No	Yes	Yes
Kenealy et al[43], 2015	98	6	New Zealand	Nurse	Daily	Daily	No	No	No	No	No
Dawson et al[44], 2021	1380	1	United States	Nurse	Daily	Daily	No	No	No	Yes	Yes
Delaney et al[45], 2013	100	3	United States	Nurse	Daily	Daily	No	No	No	No	No
Schwarz et al[46], 2008	102	3	United States	Nurse	Daily	Daily	No	No	Yes	Yes	No

Table 2 Showing the bias assessment of the primary studies

Ref.	The allocation sequence was random	The allocation sequence was adequately concealed	Participants aware of their assigned intervention	Interventions implementors were aware of participants’ assigned groups	Outcome data were available for all, or nearly all, participants randomized	Outcome measurement could have differed between groups	Outcome assessors were aware of the intervention received by participants	Data analysis plan was finalized before data were available for analysis
Nouryan et al[15], 2019	Yes	Probably yes	Yes	Yes	Yes	No	No information	No information
Seto et al[16], 2012	Yes	Yes	Yes	Yes	Yes	No	No information	No information
Weintraub et al[17], 2010	Probably yes	No information	Yes	Yes	Yes	No	No	Yes
Blum and Gottlieb[18], 2014	Probably yes	No information	Yes	Yes	Yes	No	No information	No information
Dansky et al[19], 2008	Yes	Yes	Yes	Yes	Yes	No	No	Yes
Kashem et al[20], 2008	Yes	Yes	Yes	Yes	Yes	No	No information	No information
Benatar et al[21], 2003	Probably yes	No information	Yes	Yes	Probably yes	No	No information	No information
Pedone et al[22], 2015	Probably yes	No information	Yes	Yes	Yes	No	No information	No information
Wade et al[23], 2011	Yes	No information	Yes	Yes	No	No	No information	No information
Comín-Colet et al[24], 2016	Yes	Yes	Yes	Yes	Yes	No	No	No information
Olivari et al[25], 2018	Yes	Yes	Yes	Yes	Yes	No	No information	Yes
Lyngå et al[26], 2012	Probably yes	No information	Yes	Yes	Yes	No	No information	No information
Scherr et al[27], 2009	Probably yes	No information	Yes	Yes	No	No	No information	No information
Antonicelli et al[28], 2008	Probably yes	No information	Yes	Yes	Probably yes	No	No information	No information
Giordano et al[29], 2009	Yes	Yes	Yes	Yes	Yes	No	No information	No information
Ong et al[30], 2016	Yes	Yes	Yes	Yes	Probably yes	No	No	Yes
Kalter-Leibovici et al[10], 2017	Yes	Yes	Yes	Yes	Yes	No	No	Yes
Mortara et al[31], 2009	Yes	Yes	Yes	Yes	Yes	No	No information	No information
Dar et al[32], 2009	Yes	Yes	Yes	Yes	Yes	No	No information	No information
Vuorinen et al[33], 2014	Yes	No information	Yes	Yes	Yes	No	No information	No information
Goldberg et al[34], 2003	Yes	No information	Yes	Yes	No	No	No information	No information
Soran et al[35], 2008	Yes	No information	Yes	Yes	Yes	No	No information	No information
Chaudhry et al[36], 2010	Yes	Yes	Yes	Yes	Yes	No	No	Yes
Koehler et al[13], 2018	Yes	Yes	Yes	Yes	Yes	No	No information	Yes
Cleland et al[14], 2005	Yes	Yes	Yes	Yes	Yes	No	No information	Yes
Koehler et al[7], 2011	Yes	Yes	Yes	Yes	Yes	No	No information	Yes
Kotooka et al[8], 2018	Yes	Yes	Yes	Yes	No	No	No	Yes
Pekmezaris et al[9], 2019	Yes	No information	Yes	Yes	Yes	No	No information	No information
Villani et al[37], 2014	Yes	Yes	Yes	Yes	Yes	No	No information	No information
Dendale et al[38], 2012	Yes	Yes	Yes	Yes	Yes	No	No	No information
Woodend et al[39], 2007	Yes	No information	Yes	Yes	Yes	No	No information	No information
Galinier et al[40], 2020	Yes	Yes	Yes	Yes	Yes	No	No information	No information
Capomolla et al[41], 2004	Yes	No information	Yes	Yes	No	No	No information	No information
Kulshreshtha et al[42], 2010	Yes	No	Yes	Yes	No	No	No information	No information
Kenealy et al[43], 2015	Yes	Yes	Yes	Yes	Yes	No	No	No information
Dawson et al[44], 2021	Yes	Yes	Yes	Yes	No	No	No information	No information
Delaney et al[45], 2013	Yes	Yes	Yes	Yes	Yes	No	No information	No information
Schwarz et al[46], 2008	Yes	No information	Yes	Yes	Yes	No	No information	No information

Table 3 Result of sensitivity analysis

	All-cause mortality			Cardiovascular mortality			All-cause hospitalization			Heart failure hospitalization
	No of studies	Number of patients	Effect	No of studies	Number of patients	Effect	No of studies	Number of patients	Effect	No of studies	Number of patients	Effect
Follow up ≤ 6 mo	15	6781	Reduced	3	773	Reduced	19	7442	No effect	8	2774	No effect
Follow up ≥ 12 mo	12	6159	Reduced	5	3022	Reduced	13	5360	Reduced	6	2962	Reduced
Recent hospitalization	12	5865	Reduced	3	607	Reduced	13	6057	Reduced	6	2486	No effect
No recent hospitalization	16	7417	Reduced	6	3436	Reduced	20	6993	Reduced	8	3250	Reduced
Patients ≥ 65 yr	7	1522	Reduced	-	-	-	8	1611	No effect	-	-	-