Telemonitoring for heart failure: a meta-analysis

Abstract

Aims Telemonitoring modalities in heart failure (HF) have been proposed as being essential for future organization and transition of HF care, however, efficacy has not been proven. A comprehensive meta-analysis of studies on home telemonitoring systems (hTMS) in HF and the effect on clinical outcomes are provided. Methods and results A systematic literature search was performed in four bibliographic databases, including randomized trials and observational studies that were published during January 1996–July 2022. A random-effects meta-analysis was carried out comparing hTMS with standard of care. All-cause mortality, first HF hospitalization, and total HF hospitalizations were evaluated as study endpoints. Sixty-five non-invasive hTMS studies and 27 invasive hTMS studies enrolled 36 549 HF patients, with a mean follow-up of 11.5 months. In patients using hTMS compared with standard of care, a significant 16% reduction in all-cause mortality was observed [pooled odds ratio (OR): 0.84, 95% confidence interval (CI): 0.77–0.93, I2: 24%], as well as a significant 19% reduction in first HF hospitalization (OR: 0.81, 95% CI 0.74–0.88, I2: 22%) and a 15% reduction in total HF hospitalizations (pooled incidence rate ratio: 0.85, 95% CI 0.76–0.96, I2: 70%). Conclusion These results are an advocacy for the use of hTMS in HF patients to reduce all-cause mortality and HF-related hospitalizations. Still, the methods of hTMS remain diverse, so future research should strive to standardize modes of effective hTMS.

Machine learning–based analysis of non-invasive measurements for predicting intracardiac pressures

“…A recent meta-analysis showed that these systems are significantly reducing clinical endpoints such as all-cause mortality and HF hospitalizations. 13 The results of our study when compared with the effectiveness of non-invasive telemonitoring systems may be explained by several reasons. To develop a valuable predictive model, measurements that provide useful information about the patient’s current clinical status or predict future events are essential.…”

“…Supporting this reasoning, structured telephone support that involves obtaining detailed information about signs and symptoms appears to outperform other categories of non-invasive remote monitoring. 13 As such, the current data offer both an appreciation of the abilities and limitations of the importance of the history and physical exam and longitudinal follow-up in the care of HF patients.…”

RELEASE-HF study: a protocol for an observational, registry-based study on the effectiveness of telemedicine in heart failure in the Netherlands

“…Many meta-analyses have evaluated the (cost-)effectiveness of telemedicine in patients with HF 7–19. Overall, these meta-analyses point towards a positive effect of telemedicine on hospital admission, length of hospital stay, mortality and costs 2 7–19.…”

“…Many meta-analyses have evaluated the (cost-)effectiveness of telemedicine in patients with HF 7–19. Overall, these meta-analyses point towards a positive effect of telemedicine on hospital admission, length of hospital stay, mortality and costs 2 7–19. However, the effects are heterogeneous across subgroups20–24 and vary with telemedicine components, such as type of monitored functions, number of alerts and risk of alert fatigue, contact with healthcare professional, type of device, and different quality of usual care 7 14 15 19 25.…”

Photoplethysmography and intracardiac pressures: early insights from a pilot study

“…A recent comprehensive meta-analysis demonstrated the efficacy of both invasive and non-invasive RM in lowering all-cause mortality and HF-related hospitalizations. 2 Non-invasive RM primarily addresses symptomatic HF, whereas invasive approaches, relying on haemodynamic parameters including the pulmonary capillary wedge pressure (PCWP), can detect deterioration even before symptoms manifest. 3 This offers the advantage of a more extended time window for intervening in HF deterioration, however, cost constraints and healthcare system limitations restrict its use.…”