Systematic review of studies on telemonitoring of patients with congestive heart failure: a meta-analysis
Abstract
We conducted a systematic review of large, well-conducted randomised trials designed to evaluate the effectiveness of telemonitoring on patients with congestive heart failure (CHF). Two people reviewed 125 articles independently and selected 13 articles for final review. These studies concerned 3480 patients. The follow-up period of the studies was 3–15 months. Pooled estimate results showed that there was an overall reduction in all-cause mortality ( P = 0.02). There was no overall reduction in all-cause hospital admission ( P = 0.84), although there was a reduction in CHF hospital admission ( P = 0.0004). There was no reduction in all-cause emergency admission ( P = 0.67). There was no significant difference in length of stay in hospital, medication adherence or cost. Telemonitoring in conjunction with nurse home visiting and specialist unit support can be effective in the clinical management of patients with CHF and help to improve their quality of life.
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Another review focused on telemonitoring found no reduction in all-cause hospital admission for chronic heart failure from six studies (risk ratio 1.0, 95% CI 0.9 to 1.0).
“Another review which focused on telemonitoring, pooled results for chronic heart failure from six studies for all cause hospital admission did not find a reduction for this outcome (risk ratio 1.0, 95% C.I. 0.9 to 1.0) [45].”
From The Impact of Telehealthcare on the Quality and Safety of Care: A Systematic Overview (2013) · cites this paper as [45]
That review found a significant reduction in chronic heart failure related hospital admission for telemonitoring (risk ratio 0.7, 95% CI 0.6 to 0.9).
“However, for telemonitoring for chronic heart failure related hospital admission there was a significant reduction (risk ratio 0.7, 95% C.I. 0.6 to 0.9).”
From The Impact of Telehealthcare on the Quality and Safety of Care: A Systematic Overview (2013) · cites this paper as [45]
Another review comparing telemonitoring to usual care found a reduction in all-cause mortality based on 10 studies, relative risk 0.8 (95% CI 0.6 to 1.0).
“In another review which specifically only included trial arms that compared telemonitoring to usual care and excluded arms with nurse only support or telephone support, reviewers also found a reduction in all-cause mortality based on 10 studies, relative risk 0.8 (95% C.I. 0.6 to 1.0) [45]”
From The Impact of Telehealthcare on the Quality and Safety of Care: A Systematic Overview (2013) · cites this paper as [45]
In another review of heart failure, some studies included SF-36 and Minnesota Living with Heart Failure scores, both improved, but other included studies did not demonstrate an improvement in quality of life.
“In another review of heart failure some studies included scores on SF-36 and the Minnesota Living with Heart Failure score, both of these improved, however the other included studies did not demonstrate an improvement in quality of life [45].”
From The Impact of Telehealthcare on the Quality and Safety of Care: A Systematic Overview (2013) · cites this paper as [45]
Nine reviews analyzed telehealth interventions for heart failure.
“A total of 9 reviews analyzed telehealth interventions for heart failure [16,20,28,55-60].”
A 1-star meta-analysis of telemonitoring for heart failure (excluding telephone interventions) showed a significant reduction in mortality and heart failure admissions, but not all-cause admissions or emergency department visits.
“A 1-star weighted meta-analysis of telemonitoring for heart failure (excluding telephone interventions) showed a significant reduction in mortality and heart failure admissions, but not all-cause admissions or emergency department visits [57].”
For type 2 diabetes and heart failure, findings were inconsistent between reviews, and analyses of similar interventions reached different conclusions.
“For both of these conditions, however, findings were inconsistent between reviews, and analyses of similar interventions reached different conclusions [25,55,57].”
Three reviews did not provide any information at all about the included interventions.
“while three reviews did not provide any information at all about the included interventions [36,39-40].”
From Effects of Home Telemonitoring Interventions on Patients With Chronic Heart Failure: An Overview of Systematic Reviews (2015) · cites this paper as [36]
Reporting of the active ingredients of HT interventions was often poor in the included reviews and not consistently performed for all primary studies.
“However, reporting of the active ingredients of these interventions was often poor in the included reviews and not consistently performed for all primary studies (eg, [36,38-40,46,47]).”
From Effects of Home Telemonitoring Interventions on Patients With Chronic Heart Failure: An Overview of Systematic Reviews (2015) · cites this paper as [36]
Most reviews (8/15, 53%) did not provide sufficient details about the technology used in each of the included primary studies.
“most reviews (8/15, 53%) did not provide sufficient details about the technology used in each of the included primary studies [33,34,36-40,45-47]”
From Effects of Home Telemonitoring Interventions on Patients With Chronic Heart Failure: An Overview of Systematic Reviews (2015) · cites this paper as [36]
The highest reported mean age in a study was 85 years and the lowest was 48 years.
“The highest reported mean age in a study was 85 years [36] and the lowest was 48 years [39].”
From Effects of Home Telemonitoring Interventions on Patients With Chronic Heart Failure: An Overview of Systematic Reviews (2015) · cites this paper as [36]
Usual care varied across studies from in-person follow-up visits to a general practitioner or primary care provider to attendance at an outpatient clinic-based disease management program.
“Usual care varied across studies from in-person follow-up visits to a general practitioner or primary care provider to attendance at an outpatient clinic-based disease management program [33,34,36,37,47,49].”
From Effects of Home Telemonitoring Interventions on Patients With Chronic Heart Failure: An Overview of Systematic Reviews (2015) · cites this paper as [36]
Relative effects in meta-analyses that favored HT over usual care for all-cause hospitalizations ranged from 0.99 (95% CI 0.88-1.11) to 0.67 (95% CrI 0.42-0.97).
“Relative effects in meta-analyses that favored HT over usual care ranged from 0.99 (95% CI 0.88-1.11) [36] to 0.67 (95% CrI 0.42-0.97) [37].”
From Effects of Home Telemonitoring Interventions on Patients With Chronic Heart Failure: An Overview of Systematic Reviews (2015) · cites this paper as [36]
Similar relative and absolute risk reductions were also observed in the other two meta-analyses that achieved lower AMSTAR scores.
“Similar relative and absolute risk reductions were also observed in the other two meta-analyses that achieved lower AMSTAR scores [33,36].”
From Effects of Home Telemonitoring Interventions on Patients With Chronic Heart Failure: An Overview of Systematic Reviews (2015) · cites this paper as [36]
Of them, five pooled study results into a meta-analysis.
“Of them, five pooled study results into a meta-analysis [33-37].”
From Effects of Home Telemonitoring Interventions on Patients With Chronic Heart Failure: An Overview of Systematic Reviews (2015) · cites this paper as [36]
Eight reviews concurred that the impact of HT interventions on health care costs appeared to be positive in more cases than not, but in general results were statistically inconclusive and varied depending on the context and specific national health system of the study.
“Eight reviews concurred that the impact of HT interventions on health care costs appeared to be positive in more cases than not, but in general results were statistically inconclusive and varied depending on the context and specific national health system of the study [34,36,38,39,41,43,44,47].”
From Effects of Home Telemonitoring Interventions on Patients With Chronic Heart Failure: An Overview of Systematic Reviews (2015) · cites this paper as [36]
Three reviews, all of which focused on RCTs, concluded that the impact of HT on length of stay was ambivalent.
“Three reviews, all of which focused on RCTs, concluded that the impact of HT on length of stay was ambivalent [34,36,37].”
From Effects of Home Telemonitoring Interventions on Patients With Chronic Heart Failure: An Overview of Systematic Reviews (2015) · cites this paper as [36]
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- Authors
- Clarke, M., Shah, A., & Sharma, U.
- Affiliations
- Brunel University of London (GB)
- Corresponding author
- Clarke, Malcolm
- Venue
- Journal of Telemedicine and Telecare
- Publisher
- SAGE Publications
- Published
- 2011-01
- Volume
- 17
- Issue
- 1
- Pages
- 7-14
- ISSN
- 1357-633X (ISSN-L)
- 1758-1109
- OpenAlex
- W2000438169
- Cited by
- 152
- References
- 25
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 3 · 2023: 5 · 2022: 5 · 2021: 7 · 2020: 6 · 2019: 8 · 2018: 9 · 2017: 12 · 2016: 14 · 2015: 18 · 2014: 23 · 2013: 14 · 2012: 12
- FWCI
- 2.81
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Telemedicine and Telecare (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Engineering and Physical Sciences Research Council (TS/H000100/1)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Keywords
- remote patient monitoring, congestive heart failure, all-cause mortality, hospital readmission, emergency admissions, length of hospital stay, medication adherence, health care costs, nurse home visiting, quality of life
- MeSH terms
- Aged, Aged, 80 and over, Female, Heart Failure, Hospitalization, Humans, Length of Stay, Male, Middle Aged, Quality of Life, Randomized Controlled Trials as Topic, Treatment Outcome, Drug Monitoring, Monitoring, Ambulatory
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