Cochrane: Telemonitoring shrinks cost, mortality for heart failure
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"Specialized disease management programs for CHF improve survival, quality of life and reduce healthcare utilization," the authors wrote. "The overall efficacy of structured telephone support or telemonitoring as an individual component of a CHF disease management strategy remains inconclusive."
To bulk up the lack of data, Sally C. Inglis, MD, of the Baker IDI Heart and Diabetes Institute in Melbourne, Australia, and colleagues examined data from 25 studies, which enrolled 9,500 CHF patients assigned to either telemonitoring or standard care.
Sixteen of the studies evaluated structured telephone support (5,613 patients), while 11 studies evaluated telemonitoring (2,710 patients). Also, two studies tested both methods of intervention.
The average patient follow-up was between three and 18 months and all-cause mortality and CHF-related hospitalizations were used as the primary outcome. The researchers found that both structured telephone intervention and telemonitoring reduced CFH-related hospitalizations.
Telemonitoring decreased mortality rates and prevented mortality in 102 per 1,000 cases versus 154 per 1,000 cases in the control group.
The researchers found no significant differences in mortality rates between patients who underwent structured telephone support or those in the control group. These rates were 112 per 1,000 cases versus 127 per 1,000 cases, respectively.
Additionally, Inglis et al found that structured telephone support led to a decrease in the number of patients who were admitted to the hospital for worsening heart failure—164 per 1,000 cases compared to 213 of 1,000 cases in the control group.
These same rates for patients who were assigned to telemonitoring were 225 per 1,000 versus 285 per 1,000, respectively.
"These technologies can provide specialized care to a large number of patients who otherwise may have limited access to this type of specialized healthcare,” said Inglis.
The authors also found a link between the use of telemonitoring and the improvement of patients’ quality of life and healthcare costs.
"More work is required on the cost-effectiveness of telemonitoring to establish the best business models. These may vary depending on the local organization of health services. The optimal duration of monitoring has not yet been addressed,” said Inglis.
However, the researchers concluded, "Structured telephone support and telemonitoring are effective in reducing the risk of all-cause mortality and CHF-related hospitalizations in patients with CHF; they improve quality of life, reduce costs and [increase] evidence-based prescribing."