JMIR Publications

ABSTRACT

Background:

Telemonitoring studies in chronic heart failure (CHF) are characterized by mixed mortality and hospitalization outcomes which has deterred the uptake of telemonitoring in clinical practice. These mixed outcomes may reflect the diverse range of patient management strategies incorporated into telemonitoring. To address this, we compared the effects of different telemonitoring strategies on clinical outcomes.

Objective:

To identify non-invasive telemonitoring strategies attributing to improvements in all-cause mortality or hospitalization outcomes.

Methods:

Telemonitoring strategies from randomized controlled trials (RCTs) comparing telemonitoring intervention with usual care. For each strategy, we examined whether RCTs that applied the strategy in the telemonitoring intervention (Subgroup-1) resulted in a significantly lower risk ratio (RR) of all-cause mortality or incidence rate ratio (IRR) of all-cause hospitalization, compared with RCTs that did not apply the strategy (Subgroup-2).

Results:

We included 25 RCTs (n=11,150) and 18 different telemonitoring strategies. RCTs that provided medication support were found to be associated with a significant lower IRR value than RCTs that did not provide the support (p=0.0206; Subgroup-1, IRR=0.83, 95% CI, 0.71-0.96 vs Subgroup-2, IRR=1.02, 95% CI, 0.93-1.12). RCTs that applied mobile health, were associated with a significantly lower IRR (p=0.0230; IRR=0.79, 95% CI, 0.64-0.96 vs IRR=1.00, 95% CI, 0.95-1.07) and RR value (p=0.0127; RR=0.67, 95% CI, 0.53-0.86 vs RR=0.95, 95% CI, 0.84-1.07).

Conclusions:

Telemonitoring strategies involving medication support and mobile health were associated with improvements in all-cause mortality and/or hospitalization outcomes. These strategies should be prioritized in telemonitoring interventions for the management of patients with CHF.