Meta-analysis finds telemonitoring beneficial

Telephone and telemonitoring programs reduced mortality and hospitalizations for patients with heart failure, a new Cochrane review found.

The review included 25 studies comparing remote disease management to usual care, 16 of which included structured telephone support and 11 of which included telemonitoring (two studies used both technologies). All-cause mortality was significantly reduced in the patients receiving telemonitoring (risk ratio, 0.66; 95% CI, 0.54 to 0.81) and positively, although nonsignificantly, affected by the telephone programs (RR, 0.88; 95% CI, 0.67 to 0.94).

Both interventions significantly reduced heart failure-related hospitalizations, and some studies found that the programs improved quality of life, reduced health care costs and were acceptable to patients. There were also improvements in prescribing, patient knowledge and self-care compared to usual treatment. Based on the findings, review authors concluded that such programs are beneficial and may play a significant role in heart failure care for specific patients.

An accompanying editorial was less positive, however. The editorialists said that lack of follow-up in the studies made it difficult to calculate the number needed to treat, and there was some evidence of small study bias. They called for additional trials, noting that few of the studies included in the review measured quality-of-life outcomes and cost or assessed the risk of adverse events from telephone support or telemonitoring.

The authors of the review agreed that more work is required to establish cost-effective means of applying this technology. However, they concluded that no further trials comparing telephone and telemonitoring programs to usual heart failure care are needed. Instead, researchers should focus their work on tailoring these programs to best benefit specific patient groups, the authors said.

An article in the March ACP Internist assessed the potential of remote monitoring.