Table 1.
Characteristics of the included systematic reviews.
| Author |
Population (mean age, disease severity) |
Type of studya | Intervention (length of follow-up) | Outcome variables | No. of studies (sample size) |
Results | Methodological shortcomings |
| Kotb et al [8] | 10,193 patients (mean age 44-80 years, NYHAb class I-IV, most II-III) | 30 RCTsc | Telemonitoring, structured telephone support, video monitoring (6-26 months) | HFd mortality, all-cause hospitalization, HF hospitalization | 30 (10,193) |
Reduced mortality and HF hospitalization in telemonitoring and STS. | Not reported. |
| Inglis et al [9] | Mean age 57-78 years, NYHA class I-IV, most II-IV | 25 RCTs and 5 abstracts | Telemonitoring and structured telephone support (3-15 months) | All-cause mortality, hospitalization (all-cause, HF), cost, QOLe, and LOSf | 30 | Telemonitoring reduced all-cause mortality. Both telemonitoring and STS reduced HF hospitalizations, cost, and improved QOL. | Not reported. |
| Nakamura et al [10] | 3337 patients (mean age 65 years, NYHA class I-IV) | 13 RCTs | RPMg including PDAs and mobile phones | Mortality, medication management | 13 (3337) |
RPM significantly reduced the risk of mortality. | Types of control groups were varied among reviewed studies. Patients’ medications were different among studies. |
| Pandor et al [11] | 6561 patients, 1918 patients recently discharged (mean age 57-78 years, NYHA class I-IV, most II-IV) | 20 RCTs | RPM including telemonitoring and structured telephone support (3-12 months, recently discharged patients; 6-22 months, patients with stable HF) | All-cause mortality, hospitalization (HF, all-cause), QOL, system acceptability, and LOS | 20 | Reduction in mortality and all-cause hospitalization in recently discharged patients, improvement in QOL. | Reviewed studies were heterogeneous in terms of monitored parameters, HF selection criteria, sample size, and follow-up duration. |
| Smith [12] |
|
20 (RCTs and observational studies) | Telemonitoring and structured telephone support | Readmission to hospital for any reason | 20 | HF readmission reduced but evidence for all-cause readmission is inconclusive. | Studies were heterogeneous. |
| Xiang et al [13] | 7530 patients (mean age 69 years, NYHA class I-IV, most II-IV) | 33 RCTs | Telemonitoring (6-26 months) | All-cause mortality, HF hospitalization, HF-related LOS | 33 (7530) |
Significant reduction in all-cause mortality, HF hospitalization, HF-related LOS. | In some studies, sample was small and underpowered to detect a significant association. |
| Ciere et al [14] | Not reported (mean age 61-78 years, mild or moderate class of HF) | 12 (11 RCTs and 1 pre-post study) | Telehealth (6-12 months) | Knowledge, efficacy, and self-care | 12 | Associations between telehealth and knowledge, and telehealth and self-care were mixed. TH had no effect on self-efficacy. | Limited number of studies, poor methodological quality, and mixed findings. |
| Radhakrishnan and Jacelon [15] | 20-214 | 14 (12 RCTs, 8 pre-post designs, 2 quasi-experimental, and 1 pilot control) | Telehealth (1-12 months) | Self-management | 14 | Some level of improvement in self-care. | Studies had small sample size or low power for statistical analyses. There was a risk of recall bias. |
| Giamouzis et al [16] | 57-710 (mean age 44-86 years, NYHA class I-IV) | 12 RCTs, 2 multinational | Telemonitoring (6-26 months) | All-cause mortality, all-cause rehospitalization, cardiovascular hospitalization, EDh visits, bed days, days lost due to death | 12 (57-710) |
Mixed results. | Some studies had small sample size and, therefore, were underpowered to detect significant associations. |
| Clarke et al [17] | 3480 (mean age range 55-85 years, NYHA class I-IV) | 13 RCTs | Telemonitoring (3-15 months) | All-cause mortality, all-cause emergency hospital admission, LOS | 13 (3480) |
Overall reduction in all-cause mortality and HF hospital admission, no significant effects were found in all-cause emergency and hospital admission, LOS, medication adherence, or cost. | Small sample sizes, diverse control groups, interventions, and approaches in interpreting data and contacting patients. |
| Polisena et al [18] | 3082 patients (mean age 52-75 years, NYHA class I-IV) | 17 (8 RCTs and 9 observational studies) | Telemonitoring (1-12 months) | Mortality (all-cause, HF, or cardiovascular), hospitalization (HF, all-cause), ED visits (HF, all-cause), primary care or specialist visits, and home visits | 17 (3082) |
The number of ED visits, all-cause hospitalizations, and mortality reduced in telemonitoring group. Results related to the number of primary care or specialist visits and home visits were inconclusive. | Diverse patient population and length of follow-up, lack of proper blinding and randomization, and the wide range of home telemonitoring interventions. |
| Klersy et al [19] | 8612 (age range 54-81 years, NYHA III-IV) | 32 (20 RCTs, 12 cohort studies) | RPM (3-18 months) | Mortality, hospitalizations (all-cause, HF) | 32 (8612) |
The rate of mortality, hospitalizations for any cause, and hospitalizations for HF in both RCTs and cohort studies were reduced. | Not reported |
| Chaudhry et al [20] | Mean age 67.7 years, NYHA I-IV | 9 RCTs (2 single-site and 7 multicenter) | Telephone or automated symptom monitoring | All-cause mortality, hospitalizations (all-cause, HF), event rate, and ED visits | 9 | Results were mixed. Telephone-based monitoring was less expensive. | High-quality trials regarding the effectiveness of automated forms of telemonitoring are scarce. |
| Clark et al [21] | 4264 (mean age range 57-75 years, NYHA II-IV) | 14 RCTs (not reported) | Telemonitoring or structured telephone support (3-16 months) | Mortality (all-cause), readmission (all-cause, HF), QOL, cost, adherence, patient acceptability | 14 (4264) |
QOL improved and all-cause mortality reduced. No significant effect was found on all-cause readmission and HF readmission. | Small number of trials, short-term follow-up. |
| Dang et al [22] | Mean age range 53.2-79 years, NYHA II-IV | 9 RCTs (not reported) | Home telehealth remote monitoring (3-12 months) | All-cause mortality, readmissions (all-cause, HF), ED visits, LOS, clinic visit (scheduled, unscheduled) | 9 | The impact of telemonitoring on health care utilization, mortality, and cost is positive. The results for other outcome variables were mixed. | Interventions were varied in terms of technology, duration, and the process of data analysis. The patient populations were heterogeneous in terms of NYHA class, HF duration, and socioeconomic status. |
| Hughes and Granger [23] | Mean age 63.75 years | 4 RCTs, pre-post survey | Technology-based intervention to promote self-management (30 days to 12 months) | Self-management, rehospitalization, satisfaction, QOL, and cost | 4 (733) |
Technology-based interventions resulted in improved outcomes related to self-management, rehospitalizations, costs, and QOL. | The number and quality of the studies are low. |
| Maric et al [24] | 3184 (NYHA I-IV) | RCT, pre-post survey | Telemonitoring interventions (1-18 months) | Hospitalization, emergency room costs, QOL, bed days, home visits, combined events (hospital admissions, ED access/visits, mortality, left ventricular ejection fraction, and psychological moods | 56 | The reviewed studies showed a general trend toward improvement of outcome measures such as QOL, self-efficacy, hospitalization, and ED visits. | The majority of studies were not randomized and many had small sample sizes. |
| Martinez et al [25] | Mean age range 48-83 years, NYHA I-IV | RCT, descriptive, noncontrolled clinical series | Home telemonitoring (3-24 months) | Mortality, feasibility, readmissions, QOL, LOS, and cost | 42 | Many studies showed reduction in mortality, hospital readmissions, and length of hospital days and improved QOL. | Not reported. |
| Schmidt et al [26] | Not reported | 19 RCTs | Telemonitoring | Mortality and rehospitalization, QOL, health-economic benefits, acceptance of home monitoring by patients, acceptance by clinicians and influence on doctor-patient relationship, significance of telemonitoring for patient compliance | 19 | The available scientific data on vital signs monitoring are limited, yet there is evidence for a positive effect on some clinical end points, particularly mortality. Nonetheless, any possible improvement in patient-reported outcomes, such as QOL, still remains to be demonstrated. |
Not provided. |
aType of study: RCT, cohort study, or case study and multicenter or single-center study.
bNYHA: New York Heart Association.
cRCT: randomized controlled trial.
dHF: heart failure.
eQOL: quality of life.
fLOS: length of stay.
gRPM: remote patient monitoring.
hED: emergency department.
iSTS: structured telephone support