A systematic review of telemonitoring for the management of heart failure

Background: Telemonitoring allows a clinician to monitor, on a daily basis, physiological variables measured by patients at home. This provides a means to keep patients with heart failure under close supervision, which could reduce the rate of admission to hospital and accelerate discharge. Objective: To review the literature on the application of telemedicine in the management of heart failure. Methods: A literature search was conducted on studies involving telemonitoring and heart failure between 1966 and 2002 using Medline, Embase, Cochrane Library and Journal of Telemedicine and Telecare. Results: Eighteen observational studies and six randomised controlled trials involving telemonitoring and heart failure were identified. Observational studies suggest that telemonitoring; used either alone or as part of a multidisciplinary care program, reduce hospital bed-days occupancy. Patient acceptance of and compliance with telemonitoring was high. Two randomised controlled trials suggest that telemonitoring of vital signs and symptoms facilitate early detection of deterioration and reduce readmission rates and length of hospital stay in patients with heart failure. One study also showed a reduction in readmission charges. One substantial randomised controlled study showed a significant reduction in mortality at 6 months by monitoring weight and symptoms in patients with heart failure; however, no difference was observed in readmission rates. Another randomised study comparing video-consultation performed as part of a home health care programme for patients with a variety of diagnoses, suggested a reduction in the costs of hospital care, which offset the cost of video-consultation. Patients with heart failure were not reported separately. One randomised study showed no difference in outcomes between the telemonitoring group and the standard care group. Conclusion: Telemonitoring might have an important role as part of a strategy for the delivery of effective health care for patients with heart failure. Adequately powered multicentre, randomised controlled trials are required to further evaluate the potential benefits and cost-effectiveness of this intervention. (C) 2003 European Society of Cardiology. Published by Elsevier B.V. All rights reserved.