Comparative Effectiveness of Telemonitoring Versus Usual Care for Heart Failure: A Systematic Review and Meta-analysis

Yun, Ji Eun; Park, Jeong Eun; Park, Hyun-Young; Lee, Hae Young; Park, Dong Ah

doi:10.1016/j.cardfail.2017.09.006

Cited by 112 publications

(113 citation statements)

References 47 publications

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“…Other studies of telemonitoring in heart failure, using technologies other than mobile phones, have shown mixed results. Multiple meta-analyses have shown superior outcomes for telemonitoring in heart failure patients compared with standard care [ 44 - 46 ], although 2 large individual trials have been negative [ 47 , 48 ]. A recent meta-analysis included 37 RCTs with 9582 heart failure patients [ 46 ].…”

Section: Discussionmentioning

confidence: 99%

“…Multiple meta-analyses have shown superior outcomes for telemonitoring in heart failure patients compared with standard care [ 44 - 46 ], although 2 large individual trials have been negative [ 47 , 48 ]. A recent meta-analysis included 37 RCTs with 9582 heart failure patients [ 46 ]. The authors identified a reduction in all-cause mortality for telemedical interventions compared with usual care (relative risk 0.81; 95% CI 0.70 to 0.94; I 2 =0.16).…”

Section: Discussionmentioning

confidence: 99%

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Mobile Phone Technologies in the Management of Ischemic Heart Disease, Heart Failure, and Hypertension: Systematic Review and Meta-Analysis

Indraratna

Tardo

et al. 2020

JMIR Mhealth Uhealth

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Background Cardiovascular disease (CVD) remains the leading cause of death worldwide. Mobile phones have become ubiquitous in most developed societies. Smartphone apps, telemonitoring, and clinician-driven SMS allow for novel opportunities and methods in managing chronic CVD, such as ischemic heart disease, heart failure, and hypertension, and in the conduct and support of cardiac rehabilitation. Objective A systematic review was conducted using seven electronic databases, identifying all relevant randomized control trials (RCTs) featuring a mobile phone intervention (MPI) used in the management of chronic CVD. Outcomes assessed included mortality, hospitalizations, blood pressure (BP), and BMI. Methods Electronic data searches were performed using seven databases from January 2000 to June 2019. Relevant articles were reviewed and analyzed. Meta-analysis was performed using standard techniques. The odds ratio (OR) was used as a summary statistic for dichotomous variables. A random effect model was used. Results A total of 26 RCTs including 6713 patients were identified and are described in this review, and 12 RCTs were included in the meta-analysis. In patients with heart failure, MPIs were associated with a significantly lower rate of hospitalizations (244/792, 30.8% vs 287/803, 35.7%; n=1595; OR 0.77, 95% CI 0.62 to 0.97; P=.03; I2=0%). In patients with hypertension, patients exposed to MPIs had a significantly lower systolic BP (mean difference 4.3 mm Hg; 95% CI −7.8 to −0.78 mm Hg; n=2023; P=.02). Conclusions The available data suggest that MPIs may have a role as a valuable adjunct in the management of chronic CVD.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Mobile Phone Technologies in the Management of Ischemic Heart Disease, Heart Failure, and Hypertension: Systematic Review and Meta-Analysis

Indraratna

Tardo

et al. 2020

JMIR Mhealth Uhealth

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“…The methodological quality of included studies was assessed using the “Risk of Bias” tool, which includes items on selection bias, performance bias, detection bias, attrition bias, and reporting bias . All data collection and quality assessment were performed by two independent investigators (XC and SQ), and kappa statistic was used to assess the agreement between investigators .…”

Section: Methodsmentioning

confidence: 99%

Mobile Application Interventions and Weight Loss in Type 2 Diabetes: A Meta‐Analysis

Cai

Qiu

Luo

et al. 2020

Obesity

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Objective This meta‐analysis aimed to assess the effect of mobile application (app) interventions on weight loss in patients with type 2 diabetes. Methods Electronic databases were searched for randomized controlled trials examining the use of mobile app interventions with outcomes on weight loss evaluated by body weight or other measures such as BMI or waist circumference. A random‐effects model was applied to obtain weight mean differences and 95% CIs. Results Fourteen studies enrolling 2,129 patients with type 2 diabetes were included. Mobile app interventions could significantly reduce body weight (weight mean difference, −0.84 kg; 95% CI: −1.51 to −0.17 kg) and lower waist circumference (−1.35 cm; 95% CI: −2.16 to −0.55 cm) but may not decrease BMI (−0.08 kg/m2; 95% CI: −0.41 to 0.25 kg/m2). The reductions appeared to be more pronounced in patients with obesity or among studies using mobile app interventions combined with other behavior components. However, weight loss was not moderated by the functionalities of the mobile apps (all Pinteraction > 0.05) or by the intervention duration (all P > 0.87). Conclusions Mobile app interventions lead to weight loss in patients with type 2 diabetes and are worth recommending for weight loss promotion.

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“…However, despite patient acceptance [ 2 - 4 ], the diffusion of these services is lagging [ 5 ]. Meta-analyses tend to support claims of the positive impact on heart failure outcomes [ 1 , 6 - 9 ]; however, important inconsistencies in the evidence persist [ 10 ]. Inconsistencies are believed to result from the heterogeneity of the intervention and patient populations used in primary studies and the lack of consistency with which interventions are used (ie, fidelity) in clinical trials [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Evaluating the Implementation of a Mobile Phone–Based Telemonitoring Program: Longitudinal Study Guided by the Consolidated Framework for Implementation Research

Ware¹,

Ross²,

Cafazzo³

et al. 2018

JMIR Mhealth Uhealth

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BackgroundTelemonitoring has shown promise for alleviating the burden of heart failure on individuals and health systems. However, real-world implementation of sustained programs is rare.ObjectiveThe objective of this study was to evaluate the implementation of a mobile phone–based telemonitoring program, which has been implemented as part of standard care in a specialty heart function clinic by answering two research questions: (1) To what extent was the telemonitoring program successfully implemented? (2) What were the barriers and facilitators to implementing the telemonitoring program?MethodsWe conducted a longitudinal single case study. The implementation success was evaluated using the following four implementation outcomes: adoption, penetration, feasibility, and fidelity. Semistructured interviews based on the Consolidated Framework for Implementation Research (CFIR) were conducted at 0, 4, and 12 months with 12 program staff members to identify the barriers and facilitators of the implementation.ResultsOne year after the implementation, 98 patients and 8 clinicians were enrolled in the program. Despite minor technical issues, the intervention was used as intended. We obtained qualitative data from clinicians (n=8) and implementation staff members (n=4) for 24 CFIR constructs. A total of 12 constructs were facilitators clustered in the CFIR domains of inner setting (culture, tension for change, compatibility, relative priority, learning climate, leadership engagement, and available resources), characteristics of individuals (knowledge and beliefs about the intervention and self-efficacy), and process (engaging and reflecting and evaluating). In addition, we identified other notable facilitators from the characteristics of the intervention domain (relative advantage and adaptability) and the outer setting (patient needs and resources). Four constructs were perceived as minor barriers— the complexity of the intervention, cost, inadequate communication among high-level stakeholders, and the absence of a formal implementation plan. The remaining CFIR constructs had a neutral impact on the overall implementation.ConclusionsThis is the first comprehensive evaluation of the implementation of a mobile phone–based telemonitoring program. Although the acceptability of the telemonitoring system was high, the strongest facilitators to the implementation success were related to the implementation context. By identifying what works and what does not in a real-world clinical context using a framework-guided approach, this work will inform the design of telemonitoring services and implementation strategies of similar telemonitoring interventions.

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Comparative Effectiveness of Telemonitoring Versus Usual Care for Heart Failure: A Systematic Review and Meta-analysis

Cited by 112 publications

References 47 publications

Mobile Phone Technologies in the Management of Ischemic Heart Disease, Heart Failure, and Hypertension: Systematic Review and Meta-Analysis

Mobile Phone Technologies in the Management of Ischemic Heart Disease, Heart Failure, and Hypertension: Systematic Review and Meta-Analysis

Mobile Application Interventions and Weight Loss in Type 2 Diabetes: A Meta‐Analysis

Evaluating the Implementation of a Mobile Phone–Based Telemonitoring Program: Longitudinal Study Guided by the Consolidated Framework for Implementation Research

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