Effect of telemonitoring of cardiac implantable electronic devices on healthcare utilization: a meta-analysis of randomized controlled trials in patients with heart failure
Open accessAbstract
Aims: Implantable device telemonitoring (DTM) is a diagnostic adjunct to traditional face-to-face hospital visits. Remote device follow-up and earlier diagnoses facilitated by DTM should reduce healthcare utilization. We explored whether DTM reduces healthcare utilization over standard of care (SoC), without compromising patient outcomes. Methods and results: This systematic review and meta-analysis of 11 randomized controlled trials on DTM in patients with heart failure consisted of 5702 patients, with a median of 117 [interquartile range (IQR) 76–331] patients per study [age 65 years (IQR 63–67)] and follow-up range of 12–36 months. DTM was associated with a reduction in total number of visits [planned, unplanned, and emergency room (ER)] [relative risk (RR) 0.56; 95% confidence interval (CI) 0.43–0.73, P < 0.001]. Rates of cardiac hospitalizations (RR 0.96; 95% CI 0.82–1.12, P = 0.60) and the composite endpoints of ER, unplanned hospital visits, or hospitalizations (RR 0.99; 95% CI 0.68–1.43, P = 0.96) was similar between the DTM and the SoC groups. An increase in the total number of ER or unscheduled visits (RR 1.37; 95% CI 1.11–1.70, P = 0.004) was observed. This effect was consistent and statistically significant for all studies. Total and cardiac mortality were similar between the groups (DTM RR 0.90; 95% CI 0.69–1.16, P = 0.41; and DTM RR 0.93; 95% CI 0.51–1.69, P = 0.80). Monetary costs favoured DTM (10–55% reduction in five studies). Conclusions: Compared with SoC, DTM is associated with a marked reduction in planned hospital visits. In addition, DTM was associated with lower monetary costs, despite a modest increase in unplanned hospital and ER visits. DTM did not compromise survival.
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Four reviews, including two high-quality reviews, found no difference between remote monitoring with telephone support and face-to-face care to reduce planned hospital visits and to improve modifiable cardiovascular risk factors through cardiac rehabilitation.
“Four reviews, including two high-quality reviews [1, 22] found no difference between remote monitoring with telephone support and face-to-face care to reduce planned hospital visits and to improve modifiable cardiovascular risk factors through cardiac rehabilitation [22–24].”
From Telemedicine in the OECD: An umbrella review of clinical and cost-effectiveness, patient experience and implementation (2020) · cites this paper as [22]
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- Authors
- Klersy, C., Boriani, G., De Silvestri, A., Mairesse, G. H., Braunschweig, F., Scotti, V., Balduini, A., Cowie, M. R., Leyva, F., & for the Health Economics Committee of the European Heart Rhythm Association
- Affiliations
- Policlinico San Matteo Fondazione (IT)
- University of Modena and Reggio Emilia (IT)
- Service of Biometry & Statistics, IRCCS Fondazione Policlinico S Matteo , Pavia ,
- Cliniques du Sud Luxembourg (BE)
- Karolinska University Hospital (SE)
- Centre for Scientific Documentation, IRCCS Fondazione Policlinico S Matteo , Pavia ,
- Aston University (GB)
- Corresponding author
- Leyva, Francisco
- ORCID
- Venue
- European Journal of Heart Failure
- Publisher
- Oxford University Press (OUP)
- Published
- 2016-01-27
- Volume
- 18
- Issue
- 2
- Pages
- 195-204
- ISSN
- 1388-9842 (ISSN-L)
- 1879-0844
- OpenAlex
- W2281462524
- Cited by
- 120
- References
- 25
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 6 · 2023: 15 · 2022: 17 · 2021: 12 · 2020: 18 · 2019: 10 · 2018: 10 · 2017: 16 · 2016: 8
- FWCI
- 2.59
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- European Journal of Heart Failure (publishedVersion)
- PubMed (publishedVersion)
- IRIS UNIMORE (University of Modena and Reggio Emilia) (submittedVersion, cc-by)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Keywords
- cardiac implantable electronic devices, heart failure, health care utilization, hospitalization, emergency department visits, unplanned hospital visits, health care costs, mortality, telemedicine
- MeSH terms
- Delivery of Health Care, Heart Failure, Hospitalization, Humans, Randomized Controlled Trials as Topic, Health Care Costs, Telemedicine
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