Table 2.
Characteristics of included systematic reviews.
| Authors (year) | Years searched | Number and design of HT studies | Population (mean age; disease severity) | Intervention (length of follow-up) | Control group | Main conclusions |
| Clark et al (2007) [33] | 2002 to May 2006 | 5 RCTs | 807 patients (mean age range 57-75; NYHA class I-IV) | HT without home visits (Follow-up: 3-16 months) | Usual care | HT reduced all-cause mortality and HF-related hospitalizations |
| Results were mixed for quality of life and costs | ||||||
| Inglis et al, 2010 [34,48] | 2002 to Nov. 2008 | 14 RCTs | 2710 patients (mean age range 57-78 years; NYHA class I-IV; most II-IV) | HT without home visits (Follow-up: 3-15 months) | Usual care | HT reduced the risk of all-cause mortality and HF-related hospitalizations |
| HT improved quality of life and reduced costs | ||||||
| No consistent impact on length of stay | ||||||
| Polisena et al, 2010 [35,49] | 1998-2008 | 21 studies (11 RCTs, 10 observational) | 3082 patients (mean age range 52-79; NYHA class I-IV; most III-IV) | HT with or without home visits (Follow-up: 1-12 months) | Usual care | HT reduced mortality and hospitalizations |
| Patient quality of life with HT was similar or better than with usual care | ||||||
| Clarke et al, 2011 [36] | 1969 to Oct. 2009 | 13 RCTs | 3480 patients (mean age range 55-85 years; NYHA class I-IV) | HT interventions with or without home visits (Follow-up: 3-15 months) | Usual care | HT reduced all-cause mortality and HF hospitalizations |
| HT in conjunction with nurse home visiting and specialist unit support can be effective in the clinical management of patients with HF and help improve their quality of life | ||||||
| Pandor et al, 2013 [37,50] | 2002 to Jan. 2012 | 20 RCTs [10 RCTs of recently discharged patients (≤28 days) + 10 RCTs of patients with stable HF] | 6561 patients [1918 recently discharged patients (mean age range 57-78 years; NYHA class: I-IV; most II-IV); 4643 patients with stable HF (mean age not summarized; NYHA class: I-IV)] | HT without home visits using patient-initiated external electronic devices with transfer of physiological data from the patient to the health care provider by landline or mobile phone, cable network or broadband technology (Follow-up: 3-12 months, recently discharged patients; 6-22 months, patients with stable HF) | Usual care | HT with medical support provided during office hours showed beneficial trends in reducing all-cause mortality for recently discharged patients with HF. However, these effects were statistically inconclusive |
| Where usual care is below average or suboptimal, the impact of remote monitoring is likely to be greater | ||||||
| Louis et al, 2003 [38] | 1966-2002 | 24 studies (6 RCTs, 12 observational) | 2629 patients (mean age range 53-82 years; NYHA class: I-IV; most II-IV) | HT of patients using special telecare devices in conjunction with a telecommunication system (Follow-up: 2-18 months) | Usual care, home visits, and/or nurse telephone support | HT improved mortality, yet adequately powered multicenter RCTs are required to further evaluate the potential benefits and cost-effectiveness of this intervention |
| Martínez et al, 2006 [39] | 1966 to April 2004 | 42 studies (13 reports of 10 RCTs, 29 observational) | 2303 patients (5 studies did not specify number of participants) (mean age range 48-83; NYHA class I-IV; most II-IV) | HT using peripheral devices for measuring and automatically transmitting physiological data (Follow-up: 1-24 months) | Usual care, home nurse visits, pre/post HT | Reduces hospital readmissions, length of stay, mortality, emergency visits, and costs |
| It is viable, easy to use, and is widely accepted by patients and health professionals | ||||||
| Paré et al, 2007 [40] | 1990-2006 | 16 studies (7 reports of 5 RCTs, 9 observational) | Not summarized | HT as an automated process for the transmission of patient health status data (Follow-up: 1 to 36 months) | Usual care, home visits, pre/post HT | Promising patient management |
| Future studies need to build evidence related to its clinical effects, cost effectiveness, impacts on services utilization, and acceptance by health care providers | ||||||
| Chaudhry et al, 2007 [41] | 1966 to Aug. 2006 | 4 RCTs | 774 patients with HF (mean age range 59-70 years; NYHA class I-IV) | HT with or without home visits (Follow-up: not summarized) | Usual care, home visits | HT may be an effective strategy for disease management in high-risk heart failure patients , but the evidence base is currently quite limited |
| Seto 2008 [42] | up to April 2007 | 10 studies (5 RCTs, 4 observational, 1 survey) | 1394 patients with HF (mean age range 58-74 years; NYHA not summarized) | HT with a component of home physiological measurement (Follow-up: 2-36 months) | Usual care, home visits, pre/post HT | All studies found cost reductions (range: 1.6% to 68.3%) mostly related to reduced hospitalization expenditures |
| Dang et al, 2009 [43] | 1966 to Apr. 2009 | 9 RCTs | 2020 adult patients with HF (mean age range 53-79 years; NYHA class II-IV) | Home telehealth remote monitoring (ie automated or physiologic monitoring of signs and symptoms; two-way video monitoring with or without physiologic monitoring; Internet, Internet Protocol, or Web-based technologies or image capture and transfer) (Follow-up: 3-12 months) | Usual care, home visits | Telemonitoring is a promising strategy. |
| More research required to determine the ideal patient population, technology, and parameters, frequency and duration of telemonitoring, and the exact combination of case management and close monitoring that would assure consistent and improved outcomes with cost reductions in HF | ||||||
| Maric et al, 2009 [44] | Up to Aug. 2007 | 42 studies; 52 references (12 RCTs, 30 observational) | 4290 patients (9 studies did not specify number of participants) (mean age and NYHA class not summarized) | HT using modalities that transmit data to health care professionals to assist in self-monitoring (eg, telephone-based touch pad, website based modalities, video consultations, and other technology-assisted devices) (Follow-up: 1-18 months) | Usual care, home visits, nurse telephone support, pre/post HT | Most studies demonstrated improvements in outcome measures, including improved QoL and decreased hospitalizations. However, not all studies reported the same improvements and in several cases the sample sizes were relatively small |
| Paré et al, 2010 [45] | 1966-2008 | 17 studies (13 reports of 10 RCTs, 4 observational) | Not summarized | HT interventions in which physiological and biological data are transferred from the patients’ home to the telemonitoring center to monitor patients, interpret the data, and make clinical decisions (Follow-up: not summarized) | Usual care, home visits, pre/post HT | Many studies failed to show a reduction in either mortality or hospitalization rates, although a few trials have reported a trend towards shorter lengths of stay in hospital. |
| Due to the equivocal nature of current findings of HT involving patients with HF, larger trials are still needed to confirm the clinical effects of this technology for these patients. | ||||||
| Kraai et al, 2011 [46] | Up to November 2010 | 14 studies (4 RCTs, 10 observational) | 2005 patients (mean age range 50-78; NYHA not summarized) | Noninvasive remote monitoring with external equipment to measure physiologic data such as weight and blood pressure (Follow-up: not summarized) | Usual care, home visits, nurse telephone support, pre/post HT | In general, patients seemed to be satisfied or very satisfied with HT |
| Giamouzis et al, 2012 [47] | 2001 to Nov. 2011 | 12 RCTs | 3877 patients (mean age range 57-78; NYHA class I-IV; most II-IV) | HT with at least one device that measured physiological data provided by the researchers for home use (Length of follow-up: 6 to 26 months) | Usual care | Currently available trial results tend to be in favor of HT |
| HT was highly acceptable by HF patients |