Abstract
BackgroundChronic heart failure accounts for approximately 1%-2% of health care expenditures in most developed countries. These costs are primarily driven by hospitalizations and comorbidities. Telemonitoring has been proposed to reduce the number of hospitalizations and decrease the cost of treatment for patients with heart failure. However, the effects of telemonitoring on health care utilization remain unclear.ObjectiveThis systematic review aims to study the effect of telemonitoring programs on health care utilization and costs in patients with chronic heart failure. We assess the effect of telemonitoring on hospitalizations, emergency department visits, length of stay, hospital days, nonemergency department visits, and health care costs.MethodsWe searched PubMed, Embase, and Web of Science for randomized controlled trials and nonrandomized studies on noninvasive telemonitoring and health care utilization. We included studies published between January 2010 and August 2020. For each study, we extracted the reported data on the effect of telemonitoring on health care utilization. We used P<.05 and CIs not including 1.00 to determine whether the effect was statistically significant.ResultsWe included 16 randomized controlled trials and 13 nonrandomized studies. Inclusion criteria, population characteristics, and outcome measures differed among the included studies. Most studies showed no effect of telemonitoring on health care utilization. The number of hospitalizations was significantly reduced in 38% (9/24) of studies, whereas emergency department visits were reduced in 13% (1/8) of studies. An increase in nonemergency department visits (6/9, 67% of studies) was reported. Health care costs showed ambiguous results, with 3 studies reporting an increase in health care costs, 3 studies reporting a reduction, and 4 studies reporting no significant differences. Health care cost reductions were realized through a reduction in hospitalizations, whereas increases were caused by the high costs of the telemonitoring program or increased health care utilization.ConclusionsMost telemonitoring programs do not show clear effects on health care utilization measures, except for an increase in nonemergency outpatient department visits. This may be an unwarranted side effect rather than a prerequisite for effective telemonitoring. The consequences of telemonitoring on nonemergency outpatient visits should receive more attention from regulators, payers, and providers. This review further demonstrates the high clinical and methodological heterogeneity of telemonitoring programs. This should be taken into account in future meta-analyses aimed at identifying the effective components of telemonitoring programs.
Highlights
BackgroundChronic heart failure (CHF) is one of the most prevalent high-cost chronic diseases affecting at least 1%-2% of the worldwide population [1]
Our results suggest that this may be the case for most telemonitoring programs, as we found that 67% (6/9) of studies showed an increase in non-emergency department (ED) visits
This review investigated the effects of telemonitoring programs on different aspects of health care utilization
Summary
BackgroundChronic heart failure (CHF) is one of the most prevalent high-cost chronic diseases affecting at least 1%-2% of the worldwide population [1]. Changes in physiological parameters such as weight, heart rate, blood pressure, and pulse oximetry may precede cardiac events Signaling such changes through telemonitoring may enable physicians to intervene before the patient needs hospitalization or an emergency department (ED) visit [4]. Chronic heart failure accounts for approximately 1%-2% of health care expenditures in most developed countries These costs are primarily driven by hospitalizations and comorbidities. Objective: This systematic review aims to study the effect of telemonitoring programs on health care utilization and costs in patients with chronic heart failure. Conclusions: Most telemonitoring programs do not show clear effects on health care utilization measures, except for an increase in nonemergency outpatient department visits. This may be an unwarranted side effect rather than a prerequisite for effective telemonitoring. This should be taken into account in future meta-analyses aimed at identifying the effective components of telemonitoring programs
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