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Eur J Heart Fail. 2016 Feb;18(2):195-204. doi: 10.1002/ejhf.470. Epub 2016 Jan 27.

Effect of telemonitoring of cardiac implantable electronic devices on healthcare utilization: a meta-analysis of randomized controlled trials in patients with heart failure.

Author information

1
Service of Biometry & Statistics, IRCCS Fondazione Policlinico S Matteo, Pavia, Italy.
2
Cardiology Department, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy.
3
Cliniques du Sud Luxembourg, Arlon, Belgium.
4
Karolinska University Hospital, Stockholm, Sweden.
5
Centre for Scientific Documentation, IRCCS Fondazione Policlinico S Matteo, Pavia, Italy.
6
Aston Medical Research Institute, Aston Medical School, Aston University, Birmingham, UK.

Abstract

AIMS:

Implantable device telemonitoring (DTM) is a diagnostic adjunct to traditional face-to-face hospital visits. Remote device follow-up and earlier diagnoses facilitated by DTM should reduce healthcare utilization. We explored whether DTM reduces healthcare utilization over standard of care (SoC), without compromising patient outcomes.

METHODS AND RESULTS:

This systematic review and meta-analysis of 11 randomized controlled trials on DTM in patients with heart failure consisted of 5702 patients, with a median of 117 [interquartile range (IQR) 76-331] patients per study [age 65 years (IQR 63-67)] and follow-up range of 12-36 months. DTM was associated with a reduction in total number of visits [planned, unplanned, and emergency room (ER)] [relative risk (RR) 0.56; 95% confidence interval (CI) 0.43-0.73, P < 0.001]. Rates of cardiac hospitalizations (RR 0.96; 95% CI 0.82-1.12, P = 0.60) and the composite endpoints of ER, unplanned hospital visits, or hospitalizations (RR 0.99; 95% CI 0.68-1.43, P = 0.96) was similar between the DTM and the SoC groups. An increase in the total number of ER or unscheduled visits (RR 1.37; 95% CI 1.11-1.70, P = 0.004) was observed. This effect was consistent and statistically significant for all studies. Total and cardiac mortality were similar between the groups (DTM RR 0.90; 95% CI 0.69-1.16, P = 0.41; and DTM RR 0.93; 95% CI 0.51-1.69, P = 0.80). Monetary costs favoured DTM (10-55% reduction in five studies).

CONCLUSIONS:

Compared with SoC, DTM is associated with a marked reduction in planned hospital visits. In addition, DTM was associated with lower monetary costs, despite a modest increase in unplanned hospital and ER visits. DTM did not compromise survival.

KEYWORDS:

Cardiac implantable electronic devices; Heart failure; Remote monitoring; Telemonitoring

PMID:
26817628
DOI:
10.1002/ejhf.470
[Indexed for MEDLINE]
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