Telemonitoring and hemodynamic monitoring to reduce hospitalization rates in heart failure: a systematic review and meta-analysis of randomized controlled trials and real-world studies.

ABSTRACT

BACKGROUND: Heart failure is a significant problem leading to repeated hospitalizations. Telemonitoring and hemodynamic monitoring have demonstrated success in reducing hospitalization rates, but not all studies reported significant effects. The aim of this systematic review and meta-analysis is to examine the effectiveness of telemonitoring and wireless hemodynamic monitoring devices in reducing hospitalizations in heart failure. METHODS & RESULTS: PubMed and Cochrane Library were searched up to 1st May 2017 for articles that investigated the effects of telemonitoring or hemodynamic monitoring on hospitalization rates in heart failure. In 31,501 patients (mean age 68 ± 12 years; 61% male; follow-up 11 ± 8 months), telemonitoring reduced hospitalization rates with a HR of 0.73 (95% CI 0.65-0.83; P < 0.0001) with significant heterogeneity (I2 = 94%). These effects were observed in the short-term (≤ 6 months HR = 0.77, 95% CI 0.65-0.89; P < 0.01) and long-term (≥ 12 months HR = 0.73, 95% CI 0.62-0.87; P < 0.0001). In 4831 patients (mean age 66 ± 18 years; 66% male; follow-up 13 ± 4 months), wireless hemodynamic monitoring also reduced hospitalization rates with a HR of 0.60 (95% CI 0.53-0.69; P < 0.001) with significant heterogeneity (I2 = 64%).This reduction was observed both in the short-term (HR = 0.55, 95% CI 0.45-0.68; P < 0.001; I2 = 72%) and long-term (HR = 0.64, 95% CI 0.57-0.72; P < 0.001; I2 = 55%). CONCLUSIONS: Telemonitoring and hemodynamic monitoring reduce hospitalization in both short- and long-term in heart failure patients.