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

doi:10.4330/wjc.v14.i12.640

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

World J Cardiol. 2022 Dec 26;14(12):640-656. doi: 10.4330/wjc.v14.i12.640.

Authors

Chukwuemeka Anthony Umeh¹, Adrian Torbela², Shipra Saigal², Harpreet Kaur², Shadi Kazourra², Rahul Gupta², Shivang Shah^{3

4}

Affiliations

¹ Internal Medicine, Hemet Global Medical Center, Hemet, CA 92543, United States. emmyumeh@gmail.com.
² Internal Medicine, Hemet Global Medical Center, Hemet, CA 92543, United States.
³ Department of Cardiology, Loma Linda University School of Medicine, Loma Linda, CA 92350, United States.
⁴ Department of Cardiology, University of California Riverside School of Medicine, Riverside, CA 92507, United States.

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: Heart failure; Home monitoring; Remote monitoring; Telehealth; Telemonitoring.