Home Telemonitoring In Heart Failure: A Systematic Review And Meta-Analysis

We conducted a meta-analysis of twenty-six randomized controlled trials that tested the effectiveness of home telemonitoring in patients with heart failure for reducing mortality and hospital use. We used the PIcOT framework as a tool to address an important variable not previously studied: the timi...

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Bibliographic Details
Published in:Health Affairs 2018-12, Vol.37 (12), p.1983-1989
Main Authors: Pekmezaris, Renee, Tortez, Leanne, Williams, Myia, Patel, Vidhi, Makaryus, Amgad, Zeltser, Roman, Sinvani, Liron, Wolf-Klein, Gisele, Lester, Janice, Sison, Cristina, Lesser, Martin, Kozikowski, Andrzej
Format: Article
Language:English
Subjects:
Automation
Bias
Chronic illnesses
Clinical trials
Collaboration
Effectiveness
Emergency medical care
Emergency medical services
Emergency services
Government programs
Health care
Heart
Heart diseases
Heart failure
Home health care
Hospitalization
Hospitals
Intervention
Medicare
Meta-analysis
Mortality
Patients
Quality of life
Reimbursement
Studies
Systematic review
Telemedicine
Timing
Vital signs
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Summary:We conducted a meta-analysis of twenty-six randomized controlled trials that tested the effectiveness of home telemonitoring in patients with heart failure for reducing mortality and hospital use. We used the PIcOT framework as a tool to address an important variable not previously studied: the timing or duration of monitoring. specifically, we found that home telemonitoring decreased the odds of all-cause mortality and heart failure-related mortality at 180 days but not at 365 days. Home telemonitoring did not significantly affect the odds of all-cause hospitalization at 90 or 180 days, or of heart failure-related hospitalization at 180 days. At 180 days, home telemonitoring significantly increased the odds of all-cause emergency department visits. Home care provision did not moderate the effects of home telemonitoring on all-cause hospitalization. Recent regulatory changes that relaxed Medicare restrictions on telehealth reimbursement make it imperative that studies fully describe outcomes (for example, heart failure-related versus all-cause hospitalizations) and deliberately test all essential intervention elements, such as intervention duration.
ISSN:0278-2715
1544-5208
DOI:10.1377/hlthaff.2018.05087