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Cited by 327Telemedicine and Telehealth ImplementationHeart Failure Treatment and ManagementMobile Health and mHealth Applications

Effects of Home Telemonitoring Interventions on Patients With Chronic Heart Failure: An Overview of Systematic Reviews

Open access
Kitsiou, Spyros, Paré, Guy, Jaana, Mirou·2015·Journal of Medical Internet Research
DOI 10.2196/jmir.4174PMC PMC4376138
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Abstract

BACKGROUND: Growing interest on the effects of home telemonitoring on patients with chronic heart failure (HF) has led to a rise in the number of systematic reviews addressing the same or very similar research questions with a concomitant increase in discordant findings. Differences in the scope, methods of analysis, and methodological quality of systematic reviews can cause great confusion and make it difficult for policy makers and clinicians to access and interpret the available evidence and for researchers to know where knowledge gaps in the extant literature exist. OBJECTIVE: This overview aims to collect, appraise, and synthesize existing evidence from multiple systematic reviews on the effectiveness of home telemonitoring interventions for patients with chronic heart failure (HF) to inform policy makers, practitioners, and researchers. METHODS: A comprehensive literature search was performed on MEDLINE, EMBASE, CINAHL, and the Cochrane Library to identify all relevant, peer-reviewed systematic reviews published between January 1996 and December 2013. Reviews were searched and screened using explicit keywords and inclusion criteria. Standardized forms were used to extract data and the methodological quality of included reviews was appraised using the AMSTAR (assessing methodological quality of systematic reviews) instrument. Summary of findings tables were constructed for all primary outcomes of interest, and quality of evidence was graded by outcome using the GRADE (Grades of Recommendation, Assessment, Development, and Evaluation) system. Post-hoc analysis and subgroup meta-analyses were conducted to gain further insights into the various types of home telemonitoring technologies included in the systematic reviews and the impact of these technologies on clinical outcomes. RESULTS: A total of 15 reviews published between 2003 and 2013 were selected for meta-level synthesis. Evidence from high-quality reviews with meta-analysis indicated that taken collectively, home telemonitoring interventions reduce the relative risk of all-cause mortality (0.60 to 0.85) and heart failure-related hospitalizations (0.64 to 0.86) compared with usual care. Absolute risk reductions ranged from 1.4%-6.5% and 3.7%-8.2%, respectively. Improvements in HF-related hospitalizations appeared to be more pronounced in patients with stable HF: hazard ratio (HR) 0.70 (95% credible interval [Crl] 0.34-1.5]). Risk reductions in mortality and all-cause hospitalizations appeared to be greater in patients who had been recently discharged (≤28 days) from an acute care setting after a recent HF exacerbation: HR 0.62 (95% CrI 0.42-0.89) and HR 0.67 (95% CrI 0.42-0.97), respectively. However, quality of evidence for these outcomes ranged from moderate to low suggesting that further research is very likely to have an important impact on our confidence in the observed estimates of effect and may change these estimates. The post-hoc analysis identified five main types of non-invasive telemonitoring technologies included in the systematic reviews: (1) video-consultation, with or without transmission of vital signs, (2) mobile telemonitoring, (3) automated device-based telemonitoring, (4) interactive voice response, and (5) Web-based telemonitoring. Of these, only automated device-based telemonitoring and mobile telemonitoring were effective in reducing the risk of all-cause mortality and HF-related hospitalizations. More research data are required for interactive voice response systems, video-consultation, and Web-based telemonitoring to provide robust conclusions about their effectiveness. CONCLUSIONS: Future research should focus on understanding the process by which home telemonitoring works in terms of improving outcomes, identify optimal strategies and the duration of follow-up for which it confers benefits, and further investigate whether there is differential effectiveness between chronic HF patient groups and types of home telemonitoring technologies.

Verified 2026-10-06 · 2 references not checked yet

AI snapshot

Written from the paper’s full text.

TL;DR

This overview of 15 systematic reviews found that home telemonitoring for chronic heart failure was associated with reduced all-cause mortality and HF-related hospitalizations versus usual care, but the quality of evidence was moderate to low. Post-hoc analyses suggested only automated device-based and mobile telemonitoring were effective, while other technologies lacked robust data.

Key findings

  • Across high-quality reviews with meta-analysis, home telemonitoring reduced the relative risk of all-cause mortality (0.60 to 0.85) and HF-related hospitalizations (0.64 to 0.86) compared with usual care; absolute risk reductions ranged from 1.4%-6.5% and 3.7%-8.2%, respectively.
  • The strongest evidence (moderate quality) came from a Cochrane review: all-cause mortality RR 0.66 (95% CI 0.54-0.81) in 2710 patients/11 RCTs, ARR 5.2%, number needed to treat 19; HF-related hospitalizations RR 0.79 (95% CI 0.67-0.94) in 1570 patients/4 RCTs, ARR 6%.
  • Recently discharged patients (≤28 days) showed greater reductions in mortality and all-cause hospitalizations: HR 0.62 (95% CrI 0.42-0.89) and HR 0.67 (95% CrI 0.42-0.97), respectively, but quality of evidence was low.
  • Post-hoc analyses found automated device-based telemonitoring reduced all-cause mortality (RR 0.65 [0.54-0.79]) and HF-related hospitalizations (RR 0.77 [0.64-0.91]); mobile telemonitoring showed beneficial but statistically inconclusive trends; interactive voice response and video-consultation were not associated with benefit.

Methods

  • Overview of systematic reviews: searched MEDLINE, EMBASE, CINAHL, and the Cochrane Library through December 2013, updated December 2014; included 15 peer-reviewed systematic reviews published 2003-2013 (18 references), covering 105 primary HT studies.
  • Data extraction, AMSTAR quality appraisal, GRADE evidence grading, summary-of-findings tables, citation overlap analysis, and a taxonomy classifying reviews by PICO characteristics.
  • Post-hoc subgroup meta-analyses of RCTs by home telemonitoring technology used risk ratios, intention-to-treat analysis, Mantel-Haenszel method, and random-effects models; some included reviews used Bayesian credible intervals.

Limitations

  • The paper states overviews are constrained by the quality and reporting of included reviews, publication lag, and overlap between reviews; only 3/15 reviews were high quality (AMSTAR ≥8), 4 were moderate, and 8 were low quality.
  • The paper states evidence quality was moderate to low due to risk of bias, imprecision, and heterogeneity; most trials lacked details on randomization, allocation concealment, and blinding, and one third of trials contributing data received commercial funding.
  • Evident from the text: the post-hoc technology analyses were exploratory, often based on few RCTs, and should be considered hypothesis-generating; the overview found no high-quality evidence for or against home telemonitoring effectiveness.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.2196/jmir.4174

Cites

77 of 79 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 136 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Improvements in heart failure-related hospitalizations appeared to be more pronounced in patients with stable HF, with a hazard ratio of 0.70 (95% CrI 0.34-1.5).

    “Improvements in HF-related hospitalizations appeared to be more pronounced in patients with stable HF: hazard ratio (HR) 0.70 (95% credible interval [Crl] 0.34-1.5]).”
    Quote in the paperNot a substantial claim
  • Findingown data

    Four systematic reviews (27%) investigated the effects of structured telephone support in addition to home telemonitoring.

    “Four systematic reviews (27%), in addition to HT investigated the effects of structured telephone support (STS) on patients with HF [33,34,37,41].”
    Quote in the paperNot a substantial claim
  • Findingown data

    Taken collectively, home telemonitoring interventions reduce the relative risk of all-cause mortality compared with usual care, with relative risks ranging from 0.60 to 0.85.

    “Evidence from high-quality reviews with meta-analysis indicated that taken collectively, home telemonitoring interventions reduce the relative risk of all-cause mortality (0.60 to 0.85) and heart failure-related hospitalizations (0.64 to 0.86) compared with usual care.”
    Quote in the paperSubstantial claim
  • Findingown data

    Absolute risk reduction for heart failure-related hospitalizations with home telemonitoring compared with usual care ranged from 3.7% to 8.2%.

    “Evidence from high-quality reviews with meta-analysis indicated that taken collectively, home telemonitoring interventions reduce the relative risk of all-cause mortality (0.60 to 0.85) and heart failure-related hospitalizations (0.64 to 0.86) compared with usual care. Absolute risk reductions ranged from 1.4%-6.5% and 3.7%-8.2%, respectively.”
    Quote in the paperSubstantial claim
  • Findingown data

    Quality of evidence for the outcomes of mortality and heart failure-related hospitalizations ranged from moderate to low.

    “However, quality of evidence for these outcomes ranged from moderate to low suggesting that further research is very likely to have an important impact on our confidence in the observed estimates of effect and may change these estimates.”
    Quote in the paperSubstantial claim
  • Classified as probably not a substantial claim. 42
  • May combine two claims. 40
  • The quote only partly states this claim. 2

  • Classified as probably not a substantial claim. May combine two claims.

    Findingreasoning

    Findings from home telemonitoring and structured telephone support were analyzed and reported separately, and data extracted from these reviews pertain only to home telemonitoring studies.

    “However, findings from these distinctively different interventions were analyzed and reported separately. Therefore, data extracted and presented in Table 2 from these reviews pertain only to the HT studies and not the STS ones.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    After screening titles and abstracts, 65 reviews were retrieved in full text for further assessment.

    “After screening titles and abstracts, we retrieved 65 reviews in full text for further assessment.”
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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Seven reviews originated in North America (Canada=5, United States=2), 6 in Europe (United Kingdom=3, Greece=1, Netherlands=1, Spain=1), and 2 in Australia.

    “Seven reviews (based on the corresponding author) originated in North America (Canada=5 and United States=2), 6 in Europe (United Kingdom=3, Greece=1, Netherlands=1, Spain=1), and 2 in Australia.”
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    Findingown data

    The search yielded 4683 citations after removal of 771 duplicate references.

    “our search (up to December 13, 2013) yielded 4683 citations after removal of 771 duplicate references.”
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    Findingown data

    Manual screening of references yielded 8 more reviews.

    “This process yielded 8 more reviews.”
    Quote in the paperNot a substantial claim

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    Findingown data

    The total number of identified studies was 105; 38 (36%) were randomized controlled trials and 67 (64%) were observational studies.

    “The total number of identified studies was 105; 38 (36%) referring to RCTs and 67 (64%) to observational studies.”
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    Findingown data

    After further assessment, 55 articles were excluded that did not meet eligibility criteria.

    “After further assessment, we excluded 55 articles that did not meet our eligibility criteria.”
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    Findingnone given

    All included reviews were published in peer-reviewed journals.

    “All reviews were published in peer-reviewed journals.”
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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Reviews were published between 2003 and 2013, with more than half (n=9) published in 2009 or later.

    “Reviews were published between 2003 and 2013, with more than half (n=9) published in 2009 or later.”
    Quote in the paperNot a substantial claim

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    Findingown data

    The number of home telemonitoring studies identified and included in the reviews ranged from 4 to 42, with a mean of 17.53 (SD 11.4).

    “The number of HT studies identified and included in the reviews ranged from 4 to 42: mean 17.53 (SD 11.4).”
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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingnone given

    Two systematic reviews were initially published as Health Technology Assessment reports and one as a Cochrane review.

    “However, two systematic reviews were initially published as Health Technology Assessment reports and one as a Cochrane review.”
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    Findingown data

    The post-hoc analysis identified five main types of non-invasive telemonitoring technologies included in the systematic reviews: video-consultation, mobile telemonitoring, automated device-based telemonitoring, interactive voice response, and Web-based telemonitoring.

    “The post-hoc analysis identified five main types of non-invasive telemonitoring technologies included in the systematic reviews: (1) video-consultation, with or without transmission of vital signs, (2) mobile telemonitoring, (3) automated device-based telemonitoring, (4) interactive voice response, and (5) Web-based telemonitoring.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Five reviews (33%) contained meta-analysis for at least one primary outcome of interest, while the remaining 10 used narrative synthesis.

    “Five reviews (33%) contained meta-analysis for at least one primary outcome of interest, while the remaining 10 used narrative synthesis.”
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    Findingown data

    The NYHA class of participants in all but one review ranged from I to IV.

    “The NYHA class of participants in all but one review ranged from I to IV.”
    Quote in the paperNot a substantial claim

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    Findingcitation

    One review focused primarily on HF patients who had been recently discharged (within 28 days) from an acute care setting after a recent HF exacerbation and conducted additional analyses to assess whether results differed from studies with stable HF patients.

    “One review [37] focused primarily on HF patients who had been recently discharged (within 28 days) from an acute care setting after a recent HF exacerbation and conducted additional analyses to assess whether or not the results from these studies differed markedly from the results of studies that included patients with stable HF.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [37] source

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    Findingown data

    Reviews consisted of a family of complex HT interventions, rather than a single type, involving various telehealth devices and other chronic disease management strategies.

    “Reviews consisted of a family of complex HT interventions, rather than a single type, involving various telehealth devices”
    Quote in the paperNot a substantial claim

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    Findingcitation

    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]).”
    Quote in the paperSubstantial claim0 of 6 sources checked
    • cites [36] source

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    • cites [38] Louis, Amala A, 2003, Eur J Heart Fail source

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    Findingnone given

    The remaining reviews, in addition to usual care, included RCTs that compared HT with other relevant comparators (eg, home visits or telephone support).

    “The remaining reviews, in addition to usual care, included RCTs that compared HT with other relevant comparators (eg, home visits or telephone support).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingcitation

    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].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [36] source

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    • cites [39] source

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    Findingown data

    The most frequently reported outcomes included all-cause mortality (11/15, 73%), hospital re-admissions (13/15, 87%), costs (12/15, 80%), and length of stay (9/15, 60%).

    “Most frequently reported outcomes included all-cause mortality (11/15, 73%), hospital re-admissions (13/15, 87%), costs (12/15, 80%), and length of stay (9/15, 60%).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    The majority of systematic reviews reported the mean age (12/15, 80%) and NYHA class of participants (10/15, 67%).

    “the majority of systematic reviews reported the mean age (12/15, 80%) and New York Heart Association (NYHA) class of the participants (10/15, 67%).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Six reviews made a distinction between all-cause and HF-related hospitalizations, while the remaining reviews did not.

    “Six reviews made a distinction between all-cause and HF-related hospitalizations, while the remaining reviews did not.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    Relative risk reductions in the four reviews that incorporated meta-analysis ranged from 14% (HR 0.86 [95% CI 0.61-1.21)] to 36% (HR 0.64 [95% CrI 0.34-1.14]), while the ARR in HF-related hospitalizations extended from 3.7%-8.2%.

    “Relative risk reductions in the four reviews that incorporated meta-analysis ranged from 14% (HR 0.86 [95% CI 0.61-1.21)] [37] to 36% (HR 0.64 [95% CrI 0.34-1.14]), while the ARR in HF-related hospitalizations extended from 3.7%-8.2%.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [37] source

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    Findingreasoning

    The ratio of cited to total published observational studies remained the same, as virtually all reviews that included studies with observational designs were classified in the same group (Comparison 6).

    “The ratio of cited to total published observational studies remained the same, as virtually all reviews that included studies with observational designs were classified in the same group (Comparison 6).”
    Quote in the paperNot a substantial claim

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    Findingown data

    The analysis yielded a mean ratio of 0.87 (95% CI 0.29-1.44) for RCTs in Comparison group 1, a mean ratio of 0.66 (95% CI 0.43-0.90) for RCTs in Comparison group 5, and a mean ratio of 0.48 (95% CI 0.28-0.67) for RCTs in Comparison group 6.

    “Overall, the analysis yielded a mean ratio of 0.87 (95% CI 0.29-1.44) for RCTs in Comparison group 1, a mean ratio of 0.66 (95% CI 0.43-0.90) for RCTs in Comparison group 5, and a mean ratio of 0.48 (95% CI 0.28-0.67) for RCTs in Comparison group 6.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingcitation

    Remote monitoring strategies included STS, HT with clinical support during office hours, and HT with clinical support provided 24/7.

    “Remote monitoring strategies included STS, HT with clinical support during offices hours, and HT with clinical support provided 24/7.”
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    Findingcitation

    The remaining six summarized the available evidence narratively using various qualitative or semi-quantitative techniques.

    “The remaining six summarized the available evidence narratively using various qualitative or semi-quantitative techniques [38,39,41,43,45].”
    Quote in the paperNot a substantial claim0 of 5 sources checked
    • cites [38] Louis, Amala A, 2003, Eur J Heart Fail source

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    • cites [39] source

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    • cites [41] source

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    Findingown data

    Compliance, acceptability, emergency room visits, and patient satisfaction were reported in less than half of the reviews and thus were excluded from our analysis.

    “Compliance, acceptability, emergency room visits, and patient satisfaction were reported in less than half of the reviews and thus were excluded from our analysis.”
    Quote in the paperSubstantial claim

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    Findingown data

    The methodological quality of the reviews varied considerably, and many of them had important limitations.

    “The methodological quality of the reviews varied considerably, and many of them had important limitations (Table 5).”
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    Findingcitation

    Of them, five pooled study results into a meta-analysis.

    “Of them, five pooled study results into a meta-analysis [33-37].”
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    Findingown data

    Other reviews had a broader scope of inquiry and examined the effects of HT interventions (with or without home visits) versus a variety of comparison interventions, including usual care, nursing telephone support, and/or home care.

    “Other reviews had a broader scope of inquiry and examined the effects of HT interventions (with or without home visits) versus a variety of comparison interventions, including usual care, nursing telephone support, and/or home care.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Findingnone given

    Overall, reviews concluded that HT improved quality of life.

    “Overall, reviews concluded that HT improved quality of life.”
    Quote in the paperNot a substantial claim

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    Findingcitation

    In one high-quality review, the authors concluded that HT improves quality of life, but only three of the seven studies that reported data for this outcome found positive and statistically significant improvements.

    “For example, in one of the high-quality reviews, the authors concluded that HT improves quality of life, but only three of the seven studies that reported data for this outcome found positive and statistically significant improvements.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Findingown data

    The four categories were (1) automated device-based telemonitoring (TM and TM+), (2) mobile telemonitoring (MT), (3) automated interactive voice response (IVR), and (4) video-consultation with trans-telephonic vital signs monitoring (VC+).

    “These included (1) automated device-based telemonitoring (TM and TM+), (2) mobile telemonitoring (MT), (3) automated interactive voice response (IVR), and (4) video-consultation with trans-telephonic vital signs monitoring (VC+).”
    Quote in the paperSubstantial claim

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    Findingnone given

    These interventions were further categorized into three mutually exclusive subgroups, based on the technological characteristics of the intervention, as well as methods of data collection and transmission.

    “These interventions were further categorized into three mutually exclusive subgroups, based on the technological characteristics of the intervention, as well as methods of data collection and transmission.”
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    Findingown data

    In the other two mobile telemonitoring studies, the process of measurement and transmission was not automated.

    “In the other two studies, the process of measurement and transmission was not automated.”
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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Two of the other communication platform studies used structured telephone support only, while a third study used a pager to transmit computer-generated reminders to the patient.

    “Two used structured telephone support only (denoted in Figure 3 as “STS”), while a third study used a pager to transmit computer-generated reminders to the patient to take medications, weigh themselves, and measure their blood pressure and heart rate.”
    Quote in the paperNot a substantial claim

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    Findingown data

    No significant differences were found for all-cause mortality with videoconferencing with trans-telephonic monitoring (RR 0.95 [0.35-2.53], P=.91) owing to the small number of patients and events.

    “No significant differences were found for all-cause mortality (RR 0.95 [0.35-2.53], P=.91) owing to the small number of patients and events.”
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    Findingnone given

    Three observational studies cited across 4 systematic reviews involved the use of other communication platforms that could not be classified under any of the above categories.

    “Three observational studies cited across 4 systematic reviews involved the use of other communication platforms that could not be classified under any of the above categories.”
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    Findingreasoning

    Eleven reviews examined the effects of HT interventions on cost savings, but none of them pooled results into a meta-analysis due to the inconsistency in cost-analysis methods used in the original studies.

    “Eleven reviews examined the effects of HT interventions on cost savings, but none of them pooled results into a meta-analysis due to the inconsistency in cost-analysis methods used in the original studies.”
    Quote in the paperNot a substantial claim

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    Findingown data

    When considered collectively, HT interventions without home visits are associated with a statistically significant relative risk reduction of all-cause mortality (RR 0.73 [0.62-0.85], P<.001) and HF-related hospitalizations (RR 0.79 [0.69-0.91], P=.001) of 27% and 21%, respectively.

    “As shown at the bottom of Table 10, when considered collectively, HT interventions without home visits are associated with a statistically significant, relative risk reduction of all-cause mortality (RR 0.73 [0.62-0.85], P<.001) and HF-related hospitalizations (RR 0.79 [0.69-0.91], P=.001) of 27% and 21%, respectively.”
    Quote in the paperSubstantial claim

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    Findingreasoning

    In the remaining videoconferencing studies (1 RCT and 3 observational), the intervention involved use of stand-alone videoconferencing equipment without transmission of vital signs.

    “In the remaining studies (1 RCT and 3 observational), the intervention involved use of stand-alone videoconferencing equipment without transmission of vital signs.”
    Quote in the paperNot a substantial claim

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    Findingown data

    This overview appraised and summarized evidence from 15 systematic reviews assessing the effects of HT interventions on patients with HF.

    “This overview appraised and summarized evidence from 15 systematic reviews assessing the effects of HT interventions on patients with HF.”
    Quote in the paperSubstantial claim

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    Findingcitation

    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].”
    Quote in the paperSubstantial claim0 of 8 sources checked
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    • cites [38] Louis, Amala A, 2003, Eur J Heart Fail source

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    Findingown data

    Studies that involved telemonitoring of vital signs and symptoms through individualized symptom response systems (TM+) yielded slightly smaller effects with respect to all-cause mortality and all-cause hospitalizations than studies involving telemonitoring of vital signs only (TM), but this difference was not statistically significant.

    “Studies that involved telemonitoring of vital signs and symptoms through individualized symptom response systems (TM+) yielded slightly smaller effects with respect to all-cause mortality and all-cause hospitalizations than studies involving telemonitoring of vital signs only (TM). However, this difference was not statistically significant.”
    Quote in the paperNot a substantial claim

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    Findingcitation

    Evidence about cost-effectiveness of HT remains limited, and there are no reliable data on the long-term benefits and economic implications of HT interventions.

    “Evidence about cost-effectiveness remains limited, and there are no reliable data on the long-term benefits and economic implications of HT interventions [51].”
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    Findingown data

    There exists a considerable body of evidence evaluating the effectiveness of HT interventions for patients with HF.

    “As shown in this overview, there exists a considerable body of evidence evaluating the effectiveness of HT interventions for patients with HF.”
    Quote in the paperSubstantial claim

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    Findingown data

    Compared with usual care, HT interventions improve survival rates and reduce the risk of HF-related hospitalizations.

    “The results from the principal analysis of this overview suggest that compared with usual care, HT interventions improve survival rates and reduce the risk of HF-related hospitalizations.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    Quality of evidence in included systematic reviews was assessed by outcome using the GRADE system criteria.

    “Quality of evidence in included systematic reviews was assessed by outcome using the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) system criteria [17-27].”
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    • cites [18] source

      Not checked in the free run.

    • cites [19] source

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    • cites [20] source

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    • cites [21] source

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    • cites [22] source

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    • cites [23] source

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    • cites [24] source

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    • cites [25] source

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    • cites [26] source

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    AMSTAR is a validated instrument that uses 11 items to assess the degree to which review methods are unbiased.

    “AMSTAR is a validated instrument that uses 11 items to assess the degree to which review methods are unbiased.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [16] source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Further research is very likely to have an important impact on confidence in the observed estimates of effect for mortality and heart failure-related hospitalizations and may change these estimates.

    “However, quality of evidence for these outcomes ranged from moderate to low suggesting that further research is very likely to have an important impact on our confidence in the observed estimates of effect and may change these estimates.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    In cases where reviews had not performed a risk of bias assessment, the overview authors performed this task independently using the six criteria of the Cochrane Collaboration tool.

    “In cases where reviews had not performed a risk of bias assessment, we performed this task independently using the six criteria of the Cochrane Collaboration tool [28].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [28] Higgins, Julian PT, 2008, Cochrane Handbook for Systematic Reviews of Interventions: Cochrane Book Series source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductown data

    The methodological quality of the included systematic reviews was independently assessed by the first two authors using the AMSTAR tool.

    “The methodological quality of the included systematic reviews was independently assessed by the first two authors using the Assessment of Multiple Systematic Reviews (AMSTAR) tool [16].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [16] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The Cochrane Collaboration methodology and available methodological guidelines for overviews of reviews were rigorously applied throughout this study.

    “As shown below, the Cochrane Collaboration methodology [11] and available methodological guidelines for overviews of reviews [12,13] were rigorously applied throughout this study.”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [11] Becker, LA, 2008, Cochrane Handbook for Systematic Reviews of Interventions: Cochrane Book Series source

      Not checked in the free run.

    • cites [12] source

      Not checked in the free run.

    • cites [13] Whitlock, Evelyn P, 2008, Ann Intern Med source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Full-text articles were independently assessed for inclusion by the first two authors.

    “Full-text articles were then retrieved and independently assessed for inclusion by the first 2 authors.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Home telemonitoring can be particularly helpful for patients with chronic heart failure living in remote and rural areas, the elderly and frail who are housebound, and those at high risk of deterioration.

    “It can be particularly helpful for those living in remote and rural areas, the elderly and frail who are housebound, as well as those at high risk of deterioration [5].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [5] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    No language restrictions were applied in the search.

    “No language restrictions were applied.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Premisecitation

    Overviews of systematic reviews are an efficient way to gather and summarize in a single source the best available evidence on the effectiveness of interventions.

    “Overviews of systematic reviews are an efficient way to gather and summarize in a single source the best available evidence on the effectiveness of interventions.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [10] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    To ensure consistency of assessment between the two assessors, decision support rules for scoring each AMSTAR criterion were developed.

    “To ensure consistency of assessment between the 2 assessors, we developed decision support rules for scoring each criterion (Multimedia Appendix 2).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Data were extracted by the first author and verified for accuracy by the second author.

    “Data were extracted by the first author and were verified for accuracy by the second.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Titles and abstracts were screened by the first author according to pre-specified inclusion criteria.

    “In the preliminary stage, all titles and abstracts were screened by the first author according to the pre-specified inclusion criteria described in Table 1.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    A recent critical review indicated that among all chronic conditions, heart failure has attracted the highest number of primary studies and systematic reviews.

    “A recent critical review indicated that among all chronic conditions, HF has attracted the highest number of primary studies and systematic reviews [7].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [7] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Searches were supplemented by manual searching of two relevant scientific journals and screening of relevant reviews' bibliographies.

    “Searches were supplemented by manual searching of two relevant scientific journals (ie, Journal of Telemedicine and Telecare and Telemedicine and e-Health) and screening of relevant reviews’ bibliographies.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    The strongest evidence (moderate quality) comes from a high-quality meta-analysis of 4 large RCTs (N=1570 patients), which found statistically significant risk reductions of 21% in HF-related hospitalizations with HT versus usual care, equating to an ARR of 6% (95% CI-1.7 to -9.7).

    “As shown in Table 9, the strongest evidence (moderate quality) comes from a high-quality meta-analysis of 4 large RCTs (N=1570 patients), which found statistically significant risk reductions of 21% in HF-related hospitalizations with HT versus usual care, equating to an ARR of 6% (95% CI-1.7 to -9.7) [34].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [34] source

      Not checked in the free run.

  • May combine two claims. The quote only partly states this claim.

    Premisecitation

    HT with 24/7 clinical support yielded beneficial but marginally lower relative effects than those observed in recently discharged patients: HR 0.84 (95% CrI 0.54-1.15); ARR 5.7% (-1.8 to 4.8%).

    “While HT with 24/4 clinical support yielded beneficial but marginally lower relative effects than those observed in recently discharged patients: HR 0.84 (95% CrI 0.54-1.15); ARR 5.7% (-1.8 to 4.8%).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [37] source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In the pooling of all-cause mortality data from 11 RCTs involving 2710 patients with HF, HT resulted in statistically significant risk reduction of 34% (RR 0.66 [95% CI 0.54-0.81]); an ARR of 5.2% (95% CI -2.9 to -7.1), equating to a number needed to treat of 19 to postpone one death.

    “In the pooling of all-cause mortality data from 11 RCTs involving 2710 patients with HF, HT resulted in statistically significant risk reduction of 34% (RR 0.66 [95% CI 0.54-0.81]); an ARR of 5.2% (95% CI -2.9 to -7.1), equating to a number needed to treat of 19 to postpone one death.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [34] source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    Results for HF-related hospitalizations were statistically inconclusive and the overall quality of evidence was low, suggesting that these estimates should be interpreted with caution until more evidence accumulates.

    “However, results were statistically inconclusive and the overall quality of evidence was found to be low, suggesting that these estimates should be interpreted with caution until more evidence accumulates.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [37] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The authors were able to extract data from all 105 primary studies, with the exception of 8 observational studies that could not be retrieved.

    “We were able to extract data from all 105 primary studies, with the exception of 8 observational studies that could not be retrieved.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    The post-hoc analysis findings are hypothesis generating rather than hypothesis testing due to the exploratory nature of the investigation.

    “these findings should be interpreted with caution and be considered as hypothesis generating rather than hypothesis testing due to the exploratory nature of our investigation.”
    Quote in the paperSubstantial claim
69 of 69

  • The paper relies on this without support.

    Systematic reviews of home telemonitoring for heart failure have produced discordant findings in terms of direction and magnitude of home telemonitoring effects.

    “Growing interest on the effects of home telemonitoring on patients with HF has led to a rise in the number of reviews addressing the same or very similar research questions with a concurrent increase in discordant findings in terms of direction and magnitude of HT effects.”

  • The paper relies on this without support.

    Differences in scope, methods of analysis, results, and quality of systematic reviews make it difficult for policy makers to access and interpret review-level evidence and for researchers to identify evidence gaps.

    “Differences in scope, methods of analysis, results, and quality of systematic reviews can cause great confusion and make it difficult for policy makers to access the review-level evidence, and for researchers to know where gaps in the evidence exist.”

  • The paper relies on this without support.

    Home telemonitoring enables early detection of clinical decompensation in patients with heart failure, allowing timely intervention to prevent mortality events or further deterioration necessitating hospitalization.

    “By allowing clinical data to be remotely collected on a regular basis, HT can enable early detection of clinical decompensation in patients with HF, allowing for timely intervention to prevent mortality events or further deterioration of the patient’s condition necessitating hospitalization and use of more resources.”
3 of 3

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Conclusion calls mobile telemonitoring effective despite inconclusive results

    Major

    The conclusion says mobile telemonitoring is effective at reducing mortality and HF-related hospitalizations, whereas the mobile-telemonitoring results explicitly say both outcomes were statistically inconclusive.

  • Conflicting counts of reviews reporting costs

    Minor

    The outcomes section says 12 reviews reported costs, while the cost-savings section says 11 examined that outcome.

  • Conflicting counts of reviews reporting length of stay

    Minor

    The outcomes section reports nine reviews for length of stay, but the dedicated section reports eight.

  • Louis review study-design counts do not total 24

    Minor

    The listed 6 RCTs and 12 observational studies total 18, not the stated 24 studies. The remaining six studies are not accounted for in this breakdown.

    Reported 24 · recomputed 18

  • All-cause hospitalization confidence-limit percentage is tenfold too small

    Minor

    The table's lower confidence limit of 181 fewer per 1000 is 18.1% fewer, not the 1.8% given in the prose for the same 5.7% reduction.

5 of 5

Cites

Flagged first, then by citations

Research works printed but not linked: 2

  1. Jadad, A R, 1997, CMAJ, 156, 1411
  2. ESC Press OfficeIndividualised treatment for heart failure is rarely available outside hospital - New telemonitoring systems could ‘radically’ change the situation200905302014-09-20http://www.escardio.org/about/press/press-releases/pr-09/Pages/Individualised-treatment-HF-hospital.aspxESC Press release Heart Failure Congress 2009http://www.escardio.org/about/press/press-releases/pr-09/Pages/Individualised-treatment-HF-hospital.aspx6WaYcS3L3

Cited by

Sorted by citations

Related

Authors
Kitsiou, S., Paré, G., & Jaana, M.
Affiliations
  • University of Illinois Chicago (US)
  • HEC Montréal (CA)
  • University of Ottawa (CA)
Corresponding author
Kitsiou, Spyros
ORCID
Venue
Journal of Medical Internet Research
Publisher
JMIR Publications Inc.
Published
2015-03-12
Volume
17
Issue
3
Pages
e63
ISSN
1438-8871 (ISSN-L)
DOI
10.2196/jmir.4174
PMC
PMC4376138
OpenAlex
W2074454475
Semantic Scholar
498b1218d10c77894f3f577d87d5854f58e95106
Cited by
327
References
79
Citations by year
2026: 26 · 2025: 28 · 2024: 23 · 2023: 39 · 2022: 23 · 2021: 40 · 2020: 38 · 2019: 19 · 2018: 26 · 2017: 39 · 2016: 15 · 2015: 11
FWCI
4.37
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • Journal of Medical Internet Research (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
  • McMaster University
  • Canada Research Chairs
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
home health monitoring, chronic heart failure, heart failure hospitalization, all-cause mortality, methodological quality of systematic reviews, AMSTAR, GRADE quality of evidence, heart failure exacerbation, patient-reported outcomes, quality of life, health-related quality of life, patient satisfaction
MeSH terms
Chronic Disease, Heart Failure, Hospitalization, Humans, Monitoring, Physiologic, Review Literature as Topic, Telemetry, Meta-Analysis as Topic, Telemedicine

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-06.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-06.

Statistics and arithmetic are recomputed, not judged.

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