NEW YORK (Reuters Health) – Patients with heart failure have fewer hospitalizations and lower mortality when they’re monitored remotely, either by routine telephone calls or electronic transfer of physiological data, according to results of a meta-analysis.

Previous evidence suggested that telemonitoring allows for more timely management of a patient’s worsening condition, thereby improving outcomes and lowering costs, the research team notes in the Journal of the American College of Cardiology for October 27.

To update earlier systematic reviews, Dr. Catherine Klersy, at Fondazione IRCCS Policlinico San Matteo in Pavia, Italy, and her associates reviewed the published literature from 2000 through 2008 to identify studies that compared in-person doctor visits (usual care) with either telephone monitoring, technology-assisted monitoring, or both.

Their meta-analysis included data from 20 randomized controlled trials involving 6258 patients (median age 70 years, median duration of follow-up 6 months), and 12 observational cohort studies involving 2354 patients (median age 66 years, median follow-up 12 months).

Information on illness severity was “only very partially retrievable,” the authors note. Judging from the limited data available, 54% of patients in the randomized trials and 83% in the cohort studies were in New York Heart Association functional class III to IV, and the overall median left ventricular ejection fraction was 35%-40%.

“Overall, the incidence of death, hospitalization for all causes, hospitalization for heart failure, or combined death and hospitalization was lower with the remote patient monitoring compared with the usual care approach,” the authors report.

The randomized trials showed a strong protective effect of remote monitoring on rates of hospitalization for heart failure (relative risk 0.71, p < 0.001). Remote monitoring was also associated with a lower number of deaths (RR 0.83, p = 0.006).

Cohort studies also showed lower mortality (RR 0.53) and fewer hospitalizations (RR 0.52, p < 0.001 for both) in patients assigned to remote monitoring vs usual care.

“The fact that the use of remote patient monitoring in cohort studies led to a reduction of both mortality and hospitalization, which was of similar magnitude or even greater than that observed in randomized controlled trials, may be considered a confirmation of the value of the technology,” Dr. Klersy’s team writes.

Nevertheless, they add, “Mid- and long-term cost-effectiveness of remote patient monitoring…remains to be evaluated.”

Reference:
J Am Coll Cardiol 2009;54:1683-1694.