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Non-invasive telecardiology for heart failure patients on a disease management program: Systematic review of prospective evidence
ABSTRACT
Background:
Heart failure (HF) is a disease characterized by reduced capacity of the heart to pump enough blood and oxygen to supply the organs of the body and its overall incidence is rising. The subject of this present systematic review (SR) is the use of non-invasive telemonitoring devices in chronic HF patients post-acute episode as part of a disease management program (DMP).
Objective:
The aim of this study was to systematically assess the evidence on clinical effectiveness and safety of non-invasive telemonitoring as an add-on to DMPs compared to DMPs without telemonitoring in HF patients.
Methods:
We conducted a systematic literature search in four databases supplemented by a manual search resulting in 1,351 hits. Randomized controlled trials (RCTs) published from 2010 onwards were included, EUnetHTA methodology was applied, and the risk of bias and certainty of evidence were assessed.
Results:
Three relevant RCTs were found identify¬ing the total of 527 patients (189 HF patients in telemonitoring with DMPs). The certainty of the evidence was predominantly moderate, primarily due to wide confidence intervals and small sample sizes. The follow-up period ranged from three to 24 months. The primary outcomes were rehospitalization for all causes (2 studies) and health-related quality of life (HRQoL) (1 study). Two outcomes were found to be improved by telemonitoring in a clinically significant way (rehospitalisation due to HF and HRQoL) while the rest of the outcomes were either inconclusive or not reported. No concerns were raised regarding safety.
Conclusions:
This is the first systematic review of non-invasive telemonitoring as an add-on to nurse-led DMPs for HF patients. The expected added benefit of telemonitoring is, however, based on the following core assumptions, which warrant further research: early detection enables early response, self-monitoring improves self-management, life-line to health professionals makes patients feel secure, telemonitoring helps with better distribution of resources and reduces costs. Clinical Trial: No trial registration, but Open Science Foundation registration 18.8.2025, entitled: Telecardiology for heart failure patients: Benefit assessment and evaluation concept for telemedicine-supported care programs in Austria
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