Telehealth care and remote monitoring strategies in heart failure patients: A systematic literature review

ABSTRACT Background. Heart Failure (HF) is a cardiac clinical syndrome which derive both from cardiac and extra-cardiac conditions. Heart failure is an increasing public health issue and affects a great number of people worldwide. The prevalence of heart failure is generally estimated at 1% to 2% of the general adult population, up to 10% in people aged over 70. Heart failure impacts on patients' living and working abilities, representing a high mortality-related disease. Despite the huge amount of human and economic resources employed, rehospitalization and mortality rates in heart failure patients are still alarming. A tool to safeguard unstable or non-compliant patients from deterioration of their heart failure is remote monitoring. Currently, results of remote clinical management of heart failure patients seem to be effective but not entirely convincing. This study is focused on summarizing data related to the impact of the remote monitoring strategies on heart failure patients. Objective. To synthesize evidence related to the impact of telemonitoring strategies on mortality and hospital readmissions of heart failure patients. Methods. Design. A systematic literature review and meta-analysis were conducted based on the Cochrane Handbook for Systematic Reviews of Interventions and its reporting was checked against the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Data sources. PubMed, Scopus, CINAHL, IEEE Xplore Digital Library, Engineering Source, and INSPEC were searched until August 2021. No further limits or filters were utilized in order to ensure a high sensitivity of the search strategy and adopt a broad approach. No additional search strategy was used to retrieve further data. Study selection. To be included, available full texts had to be published in English or Italian and involve heart failure patients of any NYHA class, cared with any telecare, remote monitoring, telemonitoring, or telehealth programmes. Also, articles had to collect data about crude incidence rate of mortality and number of patients who underwent rehospitalizations during follow-ups. Following the inclusion criteria, two raters independently screened titles and abstracts of retrieved references for both eligibility and inclusion in the review, with any disagreement resolved with the involvement of a third researcher. Synthesis method. To explore the effect of telemonitoring strategies on both one-year mortality and one-year rehospitalizations, studies were synthesized through meta-analyses. The Odds Ratio (OR) or Risk Ratio (when appropriate) was calculated as a principal effect size using the random effects model. Studies not included in the meta-analysis were synthesized narratively. Results. Sixty-one studies were included in the review. Narrative synthesis of data suggests a trend towards the reduction of deaths among patients who underwent telemonitoring, but number of rehospitalized patients was higher among the monitored ones. Meta-analysis of studies reporting one-year mortality outlined the protective power of care models based on telemonitoring in reducing one-year mortality (OR 0.54, 95% CI = 0.39–0.76). As well as meta-analysis of studies reporting number of rehospitalized patients in one-year outline that telemonitoring strategies are effective in reducing the number of rehospitalized patients when compared with usual care strategies (OR 0.56, 95% CI = 0.40–0.80). Substantial levels of heterogeneity found in the studies suggest to focus future research on the application of homogeneous monitoring strategies, follow-up periods, and outcome reporting. Conclusion. Evidence from studies included in this review confirms the benefits of telemonitoring in reducing mortality and rehospitalizations of HF patients. Further research is needed to reduce the heterogeneity of the studies.