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Table 4 Summary table of included reviews – heart failure

From: Telemonitoring can assist in managing cardiovascular disease in primary care: a systematic review of systematic reviews

Citation

NHMRC level of evidence

Included studies

Total participants

Inclusion criteria

Intervention

Outcomes

Results

Chaudhry et al. [21]

I

9

3582

• English language

• Published between 1966-2006

Nurse-led telephone symptom monitoring (no meta analysis) – 5 studies Automated monitoring of signs & symptoms – 1 study Automated physiological monitoring – 1 study Comparisons of two or more methods of telemonitoring (no meta-analysis) – 2 studies

• All cause and HF mortality

• All cause and HF admissions

• Cost

• Reduced all-cause hospitalisation (47%) (1 study)

• Reduced HF hospitalisations (2 studies) (20-50% reduction)

• No significant difference in HF hospitalisations (2 studies)

• Reduced emergency room visits (95% CI 0.36-0.80)(1 study)

• Reduced mortality (1 study)

• Reduced health care costs ($1000 less per patient) (1 study)

• No significant difference in all-cause hospitalisations (1 study)

• Reduced mortality (56% - 95% CI 0.22-0.85) (1 study)

• Reduced HF hospitalisations (1 study) (40% - 95% CI 0.45-0.82)

• Reduced health care costs ($276705 less 6-month cumulative readmission charges in the intervention group) (1 study)

• Both physiologic monitoring and regular nurse telephone calls showed improved mortality and hospitalisation rates compared to usual care (1 study).

• No between group differences in mortality and hospitalisation rates between physiologic monitoring and regular nurse telephone calls (12.7% vs 15.9%) (1 study).

• Both video conferencing and nursing support by telephone showed reduced 6-month HF readmission charges compared to usual care (1 study).

• No between group differences in 6-month HF readmission charges were seen between video conferencing and nursing support by telephone (1 study).

Clark et al.[10]

I

14

4264

• English language

• Published between 2002-2006

Telemonitoring – 4 studies

Structured telephone support – 9 studies

Telemonitoring and structured telephone support – 1 study

• All-cause admissions

• HF admissions

• Quality of life

• Acceptability

• Cost

• All-cause mortality

• Both interventions were associated with a statistically significant 20% reduction in all-cause mortality (RR 0.80, 95% CI: 0.69 to 0.92; 14 studies)

       

• A decrease in all-cause mortality was more pronounced with telemonitoring (RR 0.62, 95% CI: 0.45 to 0.85; 4 studies) than with structured telephone support (RR 0.85, 95% CI: 0.72 to 1.01; 9 studies)

• HF related hospitalisation was significantly reduced by 20% through remote monitoring programmes (RR 0.79, 95% CI 11%-31%).

• None of the 8 studies that reported all cause admission to hospital reported a statistically significant result. The pooled estimates also did not show significant benefit.

• 3/6 trials that investigated quality of life reported a significant and substantial improvement.

• 3/4 trials of structured telephone support reported lower healthcare costs.

• 4 trials reported acceptability of the intervention to patients.

Giamouzis et al. [22]

I

12

3,877

• English language

• Published between 1991 and November 2011

• Follow-up of at least 6 months

• At least 1 device to measure and transmit physiological data

Intervention involved recording physiological data by portable devices, and transmitting data remotely to a server.

• CVD related mortality

• All-cause mortality

• Hospitalisation/Readmissions

• Cost

Compared to controls the telemonitoring groups had:

• Reduced hospitalisation rates that reached statistical significance (3 studies)

• Reduced hospitalisation rates without reaching statistical significance (4 studies).

• Statistically significant reduced all-cause mortality (3 studies).

• Fewer reported deaths, however these results were not statistically significant (5 studies)

• Evidence for costs associated with telemonitoring were mixed with two studies finding cost reductions and one study finding increased costs.

• In four studies there were more re-hospitalisations in telemonitoring groups compared to usual care groups, but these findings were either not statistically significant or significance was not reported.

Inglis et al.[8]

I

25

8323

• Published between 1999 – 2008

Telemonitoring (transfer of daily data) – 11 studies

Structured Telephone support – 16 studies

Both interventions – 2 studies

• HF and all-cause admissions

• Quality of life

• Acceptability

• Cost

• All-cause mortality

• Length of stay

• Telemonitoring reduced all-cause mortality (RR 0.66, 95% CI: 0.54–0.81; 11 studies)

• Structured telephone support showed a non-significant trend towards reduced all-cause mortality (RR 0.88 95% CI: 0.76– 1.01; 15 studies)

• Both telemonitoring (RR 0.79, 95% CI: 0.67–0.94; 4 studies), and structured telephone support (RR 0.77, 95% CI 0.68–0.87; 13 studies) reduced chronic heart failure related hospitalisations

• Both interventions improved quality of life, reduced costs, and were acceptable to patients

• 1/6 studies reported a statistically significant reduction in length of stay, with a further 2 studies reporting a non-significant reduction

Klersy et al. [23]

I

21

5715

• Published before September 2009

• RCTS reporting hospitalisation and LOS data

Either structured telephone monitoring or technology assisted monitoring – collectively referred to as remote patient monitoring.

• Hospitalisations

• LOS

• Cost

• Quality of life

• Remote patient monitoring was associated with significantly fewer hospitalizations for HF (incidence rate ratio: 0.77, 95% CI 0.65–0.91, P < 0.001) (18 studies)

• Remote patient monitoring was associated with significantly fewer hospitalizations for any cause (incidence rate ratio: 0.87, 95% CI: 0.79–0.96, P = 0.003) (18 studies)

• LOS was not different between remote patient monitoring and usual care for either HF hospitalisations (95% CI 20.12–0.13, P = 0.88) or all-cause hospitalisation (95% CI 20.18–0.02, P = 0.83) (12 studies).

• RPM reduced costs between 300 to 1000 euros

• RPM was associated with a gain of 0.06 quality-adjusted life years – 0.02 due to reduced mortality and 0.04 due to reduced hospitalisation

Louis et al. [24]

III1

24

Not reported accurately

• English language

• Published between 1966-2002

Home monitoring using specialised devices in conjunction with a telecommunication systems.

• All-cause mortality

• HF admissions

• Length of stay

• Quality of life

• Acceptability

• Compliance

• Cost

• ED presentations

• Observational studies suggested that telemonitoring:

• Reduced hospitalisation (10 studies) and readmission rates (2 studies)

• Reduced length of stay (4 studies)

• Reduced ED presentations (2 studies)

• Reduced inpatient costs (1 study)

• Was acceptable to patients (3 studies), patients were highly satisfied (>86%)(2 studies) and improved quality of life (1 study).

Compared with usual care telemonitoring RCTs:

• Reduced hospitalisation (2 studies) and readmission rates (1 study)

• Reduced mortality (1 study)

       

• Reduced length of stay (1 study)

       

• Improved quality of life and high patient satisfaction (1 study)

Maric et al. [25]

IV2

56

--

• English language

• Published before August 2007

Device-based technologies - 16 studies

Telephone touch-pads - 12 studies

Video-consultation-based studies - 3 studies

Website-based telemonitoring - 5 studies

Combined modalities - 21

• Hospitalisation

• Quality of life

• Medication

• Cost

• Length of stay

• Decreased hospitalizations (8 studies)

• Improved QOL (5 studies)

• Fewer re-hospitalizations and combined events (1 study)

• Reduced time to target drug dosage (1 study)

• No significant changes (1 study)

• Change in mood (1 study)

• Improved QOL (1 study)

• Reduced hospital length of stay (1 study)

• Increased hospital length of stay (1 study)

• Decreased hospitalizations (7 studies)

• Reduced costs (6 studies)

Martínez et al. [26]

IV3

42

Not reported accurately

    
    

• English and Spanish language

• Published between 1951-2004

Home monitoring of HF patients using peripheral devices for measuring and automatically transmitting data.

• Cost

• Acceptability

• Health status

• Hospital admissions

• Length of stay

• Quality of life

• Feasibility/viability

• Compared to the control groups the evidence suggests that telemonitoring;

• Improved quality of life (12 studies)

• Reduced length of hospitalisation (12 studies)

• Reduced mortality (4 studies)

• Reduced costs (9 studies)

• Reduced unattended emergencies (1 study)

• Equipment easy to use (5 studies)

Seto [27]

III4

10

586

• English language

• Published between inception – April 2010

Telemonitoring systems with a component of home physiological measurements.

• Cost

• 9/10 studies analysed direct healthcare system costs. 1/10 study investigated direct patient costs.

• All the studies found cost reductions from telemonitoring compared to usual care, ranging between 1.6% and 68.3%

• Cost reductions were predominantly attributed to reduced hospitalisation expenditures.

• A 3.5% lower direct patient costs was identified, related to patient travelling.

• 55% of patients were willing to pay $20 to use telemedicine and 19% were willing to pay $40.

  1. 1RCT– 6 studies, Non-randomised – 12 studies, Observational- 6 studies.
  2. 2RCT- 23 Studies, Non Randomised – 10 Studies, Pre-post – 15 Studies, Feasibility – 1 Study, Unknown design – 8.
  3. 3RCT – 13 studies, Non-randomised – 10 studies, Clinical series or descriptive studies – 19 studies.
  4. 4RCT- 5 studies, Non-randomised - 4 studies, Survey – 1 study.