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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.