Abstract
Importance: Congestive heart failure is a major public health problem with significant human and economic cost to the healthcare system. Using remote patient monitoring devices, we can improve healthcare outcomes in patients with this condition. Objective: To evaluate the efficacy and compare Remote Patient Monitoring (RPM) devices and techniques in improving healthcare outcomes in patients with congestive heart failure. Evidence: Review An organized and thorough systematic search was performed using the 4 major electronic databases PubMed, Cochrane Library, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and EMBASE (Excerpta Medica dataBASE) from January 1st, 2016 to December 31st, 2020. MeSH (Medical Subject Headings) terms along with key words telemedicine, heart failure, and systematic reviews were used to search PubMed for all relevant studies to identify systematic reviews and meta-analysis published that evaluated the efficacy of Telemedicine interventions in heart failure patients. Similar searches were made on other 3 databases based on similar terms per their individual user guide recommendations. Reviews were selected and strength of evidence analyzed by using the Assessment of Multiple Systematic Reviews 2 (AMSTAR 2) tool. Studies were evaluated on common denominators of interventions and outcomes using standard terms. Findings: 403 reports were identified in total out of which 22 systematic reviews of randomized clinical trials and meta-analysis were identified. Variation in quality of methodologies were found with 8 reviews having AMSTAR 2 ratings of high quality. Home Tele-monitoring and Telemedicine reduced all-cause mortality rates, HF-related mortality, all-cause hospitalization and Heart Failure(HF)-related hospitalization rates. Telemedicine was associated with a small significant increase in overall quality of life. Mobile health technologies, Consumer health information technologies and invasive remote devices have shown no conclusive evidence due to limited studies. Conclusions and Relevance: This overview demonstrates high-quality evidence to support that Telemedicine has shown improvement in outcomes for patients with heart failure. Home tele-monitoring is also effective in improving outcomes but good quality evidence is lacking suggesting a need for more high quality studies and reviews.
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