Table.
Summary of heart failure studies
| Country | Study design | Total population (N) | Patient characteristics | Duration of follow-up (months) | Telemedicine group (n) | Telemedicine Intervention | WHO classification | Key findings | |
|---|---|---|---|---|---|---|---|---|---|
| Antonicelli et al (2008)13 | Italy | Randomised controlled trial | 57 | Mean age 78·0 (SD 7·1) years; 35 male participants | 12 | 28 | Telephone consultation and data monitoring (weekly electrocardiogram transmission, symptoms, adherence, blood pressure, heart rate, weight, and urine output) | Consultations between remote patient and health-care provider; remote monitoring of patient health or remote monitoring of diagnostic data by provider | Reduced mortality and hospitalisation rates in intervention group recruited after hospitalisation with heart failure, associated with better compliance with treatment than control (91% vs 43%); secondary reductions in blood pressure and cholesterol level, and better health perception reported than in controls |
| Antonicelli et al (2010)14 | Italy | Randomised controlled trial | 57 | Mean age 78·2 (SD 7·3) years; 33 male participants | 12 | 29 | Telephone consultation and data monitoring (weekly electrocardiogram transmission, symptoms, adherence, blood pressure, heart rate, weight, and urine output) | Consultations between remote patient and health-care provider; remote monitoring of patient health or remote monitoring of diagnostic data by provider | Home telemonitoring group recruited as outpatients had increased β blocker usage, lower mortality and hospital admissions, and better medication adherence than control group (89·7% vs 35·7%) |
| Böhm et al (2016)15 | Germany | Randomised controlled trial | 1002 | Mean age 66·3 (SD 10·4) years; 799 male participants | 22·9 | 505 | Text message alerts, telephone consultation, and data monitoring (fluid status) | Consultations between remote patient and health-care provider; remote monitoring of patient health or remote monitoring of diagnostic data by provider | Primary endpoint as death from any cause or first hospitalisation for cardiovascular disease was 45·0% in the intervention group and 48·1% in control group (p=0·13); all-cause death did not differ significantly between groups (p=0·52) |
| Boriani et al (2017)16 | Europe and Israel | Randomised controlled trial | 865 | Mean age 66·0 (SD 10·0) years; 133 male participants | 24 | 437 | Data monitoring (lung fluid accumulation and atrial tachyarrhythmia) | Remote monitoring of patient health or remote monitoring of diagnostic data by provider | No difference in composite and individual endpoints of death and cardiovascular-related and device-related hospitalisation between groups; a significant reduction in a composite endpoint of health-care resource use of 38% in the telemedicine vs control groups (IRR 0·62 [95% CI 0·58–0·66]; p<0·001) |
| Chaudhry et al (2010)17 | USA | Randomised controlled trial | 1653 | Median age 61·0 (IQR 51·0–73·0) years; 959 male participants | 6 | 826 | Telephone-based interactive voice-response system (symptoms and weight monitoring) | Remote monitoring of patient health or remote monitoring of diagnostic data by provider | The telemedicine group and the usual-care group did not differ significantly for all-cause mortality (11·1% in the telemonitoring group and 11·4% in the usual-care group; p=0·88) or hospital readmission (49·3% in the telemonitoring group and 47·4% in the usual-care group; p=0·45) |
| Dendale et al (2012)18 | Belgium | Randomised controlled trial | 160 | Mean age 76·0 (SD 10·0) years; 104 male participants | 6 | 80 | Bluetooth-enabled cell phone for automated data monitoring (blood pressure, weight, and heart rate), web-based, and email | Remote monitoring of patient health or remote monitoring of diagnostic data by provider | The total number of follow-up days lost to hospitalisation, dialysis, or death was significantly lower in telemedicine group as compared to usual care group (13 days vs 30 days; p=0·02) |
| Dunagan et al (2005)19 | USA | Randomised controlled trial | 151 | Mean age 70·0 (SD 13·3) years; 66 male participants | 12 | 76 | Telephone consultation | Consultations between remote patient and health-care provider | Patients assigned to telemedicine had a reduced risk of any hospital attendance (HR 0·67 [95% CI 0·47–0·96]; p=0·029) or hospital readmission (0·67 [0·46–0·99]; p=0·045). There were no significant associations with heart failure-specific readmission, functional status, mortality, or satisfaction with care. |
| Frederix et al (2019)20 | Belgium | Randomised controlled trial | 160 | Mean age 76·0 (SD 10·0) years; 93 male participants | 79 | 80 | Email, telephone consultation, and data monitoring (weight, blood pressure, and heart rate) | Consultations between remote patient and health-care provider; remote monitoring of patient health or remote monitoring of diagnostic data by provider | Telemedicine was associated with reduced days lost to heart failure readmission compared with usual care (p=0·04), but without effect on all-cause mortality (HR 0·83 [95% CI 0·57–1·20]; p=0·32) |
| Gingele et al (2019)21 | Netherlands | Randomised controlled trial | 382 | Mean age 71·0 (SD 11·0) years; 226 male participants | 26 | 197 | Telephone consultation and electronic device for data monitoring (symptoms, knowledge, and behaviour) | Consultations between remote patient and health-care provider; remote monitoring of patient health or remote monitoring of diagnostic data by provider | Telemedicine associated with fewer heart failure-related hospitalisations [IRR 0·54 [95% CI 0·31–0·88]), but no difference in time to first heart failure-related hospital admission, all-cause mortality, or days alive and out of hospital |
| Giordano et al (2009)22 | Italy | Randomised controlled trial | 460 | Mean age 57·0 (SD 10·0) years; 391 male participants | 12 | 230 | Telephone consultation and data monitoring (electrocardiogram) | Consultations between remote patient and health-care provider; remote monitoring of patient health or remote monitoring of diagnostic data by provider | 1 year home-based telemonitoring programme reduced hospital readmissions and significantly reduced the mean cost of hospital admissions by 35% among patients with chronic heart failure (€843 [SD 1733] in the intervention vs €1298 [2322] in usual care, p<0·01) |
| Guédon-Moreau et al (2013)23 | France | Randomised controlled trial | 433 | Mean age 61·6 (SD 12·5) years; 382 male participants | 24·2 | 221 | Data monitoring by implantable cardioverter-defibrillator holter (abnormal heart rhythm) | Remote monitoring of patient health or remote monitoring of diagnostic data by provider | The telemedicine home monitored group had fewer inappropriate implantable cardiac defibrillator shocks than patients with usual ambulatory monitoring (5% vs 10% with usual care; p<0·05) with non-inferiority for major adverse events |
| Koehler et al (2011)24 | Germany | Randomised controlled trial | 710 | Mean age NA; 577 male participants | 24 | 354 | Telephone consultation, wireless Bluetooth device, personal digital assistant cell phone, and data monitoring (electrocardiogram, blood pressure, and weight) | Consultations between remote patient and health-care provider; remote monitoring of patient health or remote monitoring of diagnostic data by provider | No significant effect of remote telemonitoring on all-cause mortality, cardiovascular death, or hospitalisation |
| Koehler et al (2018)25 | Germany | Randomised controlled trial | 1538 | Mean age 70·0 (SD 10·5) years; 1070 male participants | 59 | 765 | Telephone consultation and data monitoring (electrocardiogram, blood pressure, weight, and oxygen saturation) | Consultations between remote patient and health-care provider; remote monitoring of patient health or remote monitoring of diagnostic data by provider | Reduced proportion of days lost due to unplanned cardiovascular-related hospital admissions and all-cause death in a telemedicine management group compared with usual care (IRR 0·80 [95% CI 0·65–1·00]; p=0·046) |
| Kotooka et al (2018)26 | Japan | Randomised controlled trial | 181 | Mean age 66·2 (SD 14·3) years; 107 male participants | 31 | 90 | Telephone consultation, web-based, and data monitoring (blood pressure, pulse rate, weight, and body composition) | Consultations between remote patient and healthcare provider; remote monitoring of patient health or remote monitoring of diagnostic data by provider | There was no difference in the primary composite endpoint of all-cause death or rehospitalisation due to worsening heart failure between telemedicine and usual care groups (HR 0·95 [95% CI 0·55–1·65], p=0·57) |
| Lear et al (2014)27 | Canada | Randomised controlled trial | 78 | Age range 41·5–76·0 years; 66 male participants | 4 | 38 | Web-based cardiac rehabilitation, one-to-one chat consultation, email, and data monitoring (heart rate) | Consultations between remote patient and health-care provider; remote monitoring of patient health or remote monitoring of diagnostic data by provider | The telemedicine cardiac rehabilitation programme was associated with no difference in exercise capacity (45·7 [95% CI 1·04–90·48] increase in Bruce protocol time in the intervention group versus baseline, but below the specified clinically relevant threshold of 60 s) |
| López-Liria et al (2019)28 | Spain | Randomised controlled trial | 50 | Mean age 75·0 (SD 12·0) years; 24 male participants | 12 | 25 | Web-based data monitoring from implantable cardiac devices | Remote monitoring of patient health or remote monitoring of diagnostic data by provider | Following permanent pacemaker insertion, no difference observed between remote monitoring and control groups for emergency hospital visits and rehospitalisations (28% vs 32%; p=0·53); both groups showed statistically significant improvements in the baseline parameters based on the Minnesota Living with Heart Failure questionnaire |
| Lundgren et al (2016)29 | Sweden | Randomised controlled trial | 50 | Mean age 62·9 (SD 12·8) years; 29 male participants | 2 | 25 | Web-based and email consultations | Consultations between remote patient and health-care provider | No significant difference in depressive symptoms, cardiac anxiety, and quality of life for patients with heart failure between groups managed remotely using internet-based cognitive behavioural therapy and online moderated discussion forums |
| Lüthje et al (2015)30 | Germany | Randomised controlled trial | 176 | Mean age 65·9 (SD 12·0) years; 136 male participants | 15 | 87 | Data monitoring (fluid overload) | Remote monitoring of patient health or remote monitoring of diagnostic data by provider | Remote monitoring of implantable cardiac devices in patients with heart failure was associated with no difference in heart failure-related hospitalisations (HR 1·23 [95% CI 0·62–2·44]; p=0·55) or all-cause mortality compared with controls (8·6% vs 4·6% usual care at 1 year; p=0·50) |
| Morgan et al (2017)31 | England | Randomised controlled trial | 1650 | Mean age 69·5 (SD 10·2) years; 1415 male participants | 24 | 824 | Telephone consultation and data monitoring from implantable electronic devices | Consultations between remote patient and health-care provider; remote monitoring of patient health or remote monitoring of diagnostic data by provider | No significant differences between remote monitoring group and controls for a primary outcome of all-cause mortality or unplanned cardiovascular hospitalisation (42·4% vs 40·8% in usual care; p=0·87); no differences were observed for secondary outcomes |
| Piette et al (2015)32 | USA | Randomised controlled trial | 372 | Mean age 67·9 (SD 10·2) years; 366 male participants | 12 | 189 | Email and telephone consultations, and data monitoring (systematic monitoring and tailored self-management education via interactive voice response) | Consultations between remote patient and health-care provider; remote monitoring of patient health or remote monitoring of diagnostic data by provider | Telemedicine intervention using a mobile health application was associated with less caregiving strain, and better engagement of care givers with patients with heart failure than in the control group |
| Piotrowicz et al (2015)33 | Poland | Randomised controlled trial | 107 | Mean age 56·7 (SD 11·9) years; 95 male participants | 2 | 75 | Data monitoring (electrocardiogram, weight, and blood pressure) | Remote monitoring of patient health or remote monitoring of diagnostic data by provider | Significant improvement for peak oxygen uptake in the telemedicine-delivered exercise intervention group; however, there were no observed deaths or hospitalisations in either intervention or control groups |
| Rahimi et al (2020)34 | UK | Randomised controlled trial | 202 | Mean age 71·6 (SD 11·5) years; 145 male participants | 20 | 101 | Telephone consultation, tablet computer-enabled Bluetooth and app, and data monitoring (weight, blood pressure, and heart rate) | Consultations between remote patient and health-care provider; remote monitoring of patient health or remote monitoring of diagnostic data by provider | Physical wellbeing of participants did not differ significantly between telemedicine home monitoring of patients with heart failure and control groups |
| Riegel et al (2002)35 | USA | Randomised controlled trial | 358 | Mean age 72·0 (SD 12·0) years; 175 male participants | 6 | 130 | Telephone and email consultation | Consultations between remote patient and health-care provider | Significant reduction in the hospitalisation rate for heart failure (0·21 [SD 0·5] vs 0·41 [0·77 admissions per person in usual care, p=0·01), hospital days for heart failure, and multiple readmissions, and better patient satisfaction in the telemedicine intervention group than in the control group; cost savings for inpatient heart failure care were reported after deduction of the intervention costs |
| Rodríguez-Gázquez et al (2012)36 | Colombia | Randomised controlled trial | 63 | Mean age 70·0 (SD 10·5) years; 31 male participants | 9 | 33 | Telenursing sessions | Consultations between remote patient and health-care provider | Improvement in a self-care scale of at least 20% for patients managed by telemedicine compared with controls |
| Scherr et al (2009)37 | Austria | Randomised controlled trial | 120 | Median age 66·0 (IQR 62·0–72·0) years; 85 male participants | 6 | 54 | Telephone consultation, email, web-based, and data monitoring (blood pressure, heart rate, and weight) | Consultations between remote patient and health-care provider; remote monitoring of patient health or remote monitoring of diagnostic data by provider | Home telemonitoring following an episode of decompensated heart failure was associated with a non-significant trend towards a lower composite outcome of death or hospitalisation compared with controls (50% RR reduction, p=0·06) |
| Tajstra et al 202038 | Poland | Randomised controlled trial | 600 | Mean age 64·0 (SD NA) years; 487 male participants | 12 | 299 | Telephone consultation and data monitoring from remote monitoring devices | Consultations between remote patient and health-care provider; remote monitoring of patient health or remote monitoring of diagnostic data by provider | Remote monitoring and guided care of implantable cardiac devices was associated with a reduction in the primary composite outcome of all-cause mortality or cardiovascular death compared with usual care (39·5% vs 48·5% in usual care; p=0·048) |
| Thorup et al (2016)39* | Denmark | Randomised controlled trial | 119 | Mean age 62·8 (SD 11·5) years; 51 male participants | 12 | 64 | Tablet and data monitoring (blood pressure, pulse rate, weight, and daily steps) | Remote monitoring of patient health or remote monitoring of diagnostic data by provider | Increased walking from a mean of 5191 (SD 3198) to 7890 (SD 2629) steps per day among patients for cardiac diseases with remote monitoring; notably more among younger patients with better adherence to the pedometer |
| Weintraub et al (2010)40 | USA | Randomised controlled trial | 188 | Mean age 69·0 (SD 13·5) years; 124 male participants | 3 | 95 | Telephone consultation, data monitoring via automated health monitoring device (weight, blood pressure, and heart rate) | Consultations between remote patient and health-care provider; remote monitoring of patient health or remote monitoring of diagnostic data by provider | Remote telemedicine monitoring of bodyweight, blood pressure, heart rate, and self-reported health associated with a reduction in rate of heart failure hospitalisation compared with controls (risk rate 0·50 [95% CI 0·25–0·99]; p=0·05) |
| Dadosky et al (2018)41 | USA | Prospective non-randomised trial | 141 | Mean age 79·8 (SD 10·1) years; 105 male participants | 1 | 49 | Interactive tele-management video sessions and data monitoring via remote sensor (heart rate, respiration, body position, electrocardiogram, and weight) | Consultations between remote patient and health-care provider; remote monitoring of patient health or remote monitoring of diagnostic data by provider | Patients receiving the telemedicine intervention had lower rehospitalisation rates (17% vs 24%) than those receiving usual care, despite higher predicted rehospitalisation risk |
| Quinn (2006)42 | USA | Quasi-experimental study | 22 | Mean age 76·5 (SD NA) years; age range 49·0–90·0 years; 11 male participants | 3 | 22 | Telephone consultation | Consultations between remote patient and health-care provider | The frequency of reported symptoms decreased at the end of the telemedicine intervention; the hospitalisation rate was also lower than in a historical cohort with hospitalisation data available |
| Chen et al (2010)43 | Taiwan | Cohort study | 550 | Mean age 62·8 (SD 15·5) years; 387 male participants | 6 | 275 | Telephone consultation | Consultations between remote patient and health-care provider | A significantly lower all-cause admission rate per person (intervention group had 0·60 [SD 0·77] admissions per person; and usual care group had 0·96 [0·85] admissions per person), shorter length of hospital stay (reduced by 8 days per person), and lower total 6 month medical costs (reduced by US$2682 per patient) in the intervention group compared than in the usual care group. |
| Kurek et al (2017)44 | Germany | Cohort study | 574 | Median age for remote monitoring group 63·0 (IQR 56·0–69·0) years; median age for non-remote monitoring group 62·0 (IQR 53·0–70·0) years; 482 male participants | 36 | 574 | Data monitoring of implantable cardiac devices via remote monitoring online system | Remote monitoring of patient health or remote monitoring of diagnostic data by provider | Significantly lower all-cause mortality in patients under remote monitoring compared with propensity-matched controls up to 3 years of follow-up (4·9% vs 22·3% in controls; p<0·0001) |
| Mittal et al (2016)45 | USA | Cross-sectional | 106 027 | Mean age 71·6 (SD 13·0) years; 68 159 male participants | 30 | 106 027 | Telephone consultation and data monitoring from cardiac implantable electronic device | Consultations between remote patient and health-care provider; remote monitoring of patient health or remote monitoring of diagnostic data by provider | Comparisons made between early and later initiation of remote monitoring for implantable cardiac devices; prompt initiation of remote monitoring was associated with increased chance of survival (HR 1·18 [95% CI 1·13–1·22, p<0·001) |
| Martín-Lesende et al (2017)46 | Spain | Cohort study | 42 | Mean age 78·9 (SD 7·5) years; 19 male participants | 12 | 15 | Data monitoring from smartphones to web-platform (aided with alert system) | Remote monitoring of patient health or remote monitoring of diagnostic data by provider | Home-based telemedicine application and alerting system associated with reduced hospitalisation days and emergency department attendances compared with patients who were not randomised from before the intervention (1·1 [SD 1·5] vs 2·6 [1·6] admissions per patient for usual care attendances) |
| Masella et al (2008)47 | Italy | Cohort study | 67 | Mean age 64·0 (SD 9·0) years; 58 male participants | 3 | 67 | Data monitoring from implantable cardioverter defibrillator | Remote monitoring of patient health or remote monitoring of diagnostic data by provider | A remote telemonitoring service for implantable cardiac devices improved efficiency of care; only a small number of clinical events occurred in cohort study |
| Moore (2016)48 | USA | Cohort study | 22 | Median age 78·2 (IQR NA) years; 7 male participants | 4 | 22 | Telephone consultation and data monitoring (blood pressure, oxygen saturation, and weight) | Consultations between remote patient and health-care provider; remote monitoring of patient health or remote monitoring of diagnostic data by provider | Home-based telemonitoring supported by nurse practitioner reviews was associated with lower short-term admission rates to hospital compared with national average figures, but this was a small cohort |
| Nishii et al (2015)49 | Japan | Cohort study | 195 | Mean age 66·3 (SD 11·3) years; 149 male participants | 24 | 195 | Data monitoring (serum brain natriuretic peptide and fluid status) | Remote monitoring of patient health or remote monitoring of diagnostic data by provider | Device implanted to measure volume status by intrathoracic impedance triggering alerts; B-type natriuretic peptide concentrations and bodyweight were not significantly different from baseline in patients with alerts |
| Odeh et al (2015)50 | UK | Cohort study | 48 | Mean age 71·1 (SD 10·4) years; 19 male participants | 24 | 48 | Telehealth service | Consultations between remote patient and health-care provider | In a mixed observational cohort including patients with heart failure, telemedicine was associated with reduced hospital admissions compared with a pre-telemedicine period |
| Rosen et al (2017)51 | USA | Cohort study | 50 | Mean age 61·0 (SD 12·0) years; 14 male participants | 6 | 50 | Telehealth platform for daily, real-time reporting of health status, and video conferencing | Consultations between remote patient and health-care provider | Patients given telemedicine intervention did not have lower hospital admission rates compared with a previous period in this non-randomised study (37% vs 43%; p=0·32) |
| Scalvini et al (2006)52 | Italy | Cohort study | 438 | Mean age 68·2 (SD 14·8) years; 268 male participants | 12 | 226 | Teleassistance and data monitoring (electrocardiogram) | Consultations between remote patient and health-care provider; remote monitoring of patient health or remote monitoring of diagnostic data by provider | Patients with heart failure supported with a home-based telemonitoring system had more proactive health-care contacts than a comparator group managed by general practitioners; however, the cohorts differed widely in baseline risk |
HR=hazard ratio. IRR=incident rate ratio. NA=not available. OR=odds ratio. RR=risk ratio.
*
This study also included secondary cardiovascular prevention patients.