Extended Care and Research Services, Bruce W. Carter Department of Veterans Affairs Medical Center, Miami, Florida 33125, USA.
Telemed J E Health. 2009 Oct;15(8):783-96. doi: 10.1089/tmj.2009.0028.
Information and communication technology offers promise for better coordination of care for patients with congestive heart failure (CHF). MEDLINE, EMBASE, and CINHAL databases were searched for evidence on remote monitoring of patients with heart failure (HF). The search was restricted to randomized controlled trials using either automated monitoring of signs and symptoms or automated physiologic monitoring. For this review, telephone-based monitoring of signs and symptoms was not considered remote monitoring. Studies were also excluded if they did not present outcomes related to healthcare utilization. Nine studies met selection criteria, with interventions that varied greatly. Four three-arm studies directly compared the effectiveness of two different interventions to usual care. Six of the nine studies suggested a 27%-40% reduction in overall admissions. Two two-arm studies demonstrated a 40%-46% reduction in HF-related admissions while two other three-arm studies showed similar trends; however, this was not statistically significant. Three of nine studies suggested a significant reduction in mortality (30%-67%) and three studies showed significant reduction in healthcare utilization costs. Two studies suggested a 53%-62% reduction in bed days of care. Two studies showed significant reduction in the number of Emergency Department visits. Three two-arm studies and one three-arm study demonstrated significant overall improvement in outcomes with use of telemonitoring. Available data suggest that telemonitoring is a promising strategy. More data are needed to determine the ideal patient population, technology, and parameters, frequency and duration of telemonitoring, and the exact combination of case management and close monitoring that would assure consistent and improved outcomes with cost reductions in HF.
信息和通信技术为更好地协调充血性心力衰竭（CHF）患者的护理提供了希望。检索了 MEDLINE、EMBASE 和 CINHAL 数据库，以获取有关心力衰竭（HF）患者远程监测的证据。该搜索仅限于使用自动监测体征和症状或自动生理监测的随机对照试验。在本次综述中，不将基于电话的体征和症状监测视为远程监测。如果研究没有提供与医疗保健利用相关的结果，则将其排除在外。有 9 项研究符合选择标准，干预措施差异很大。四项三臂研究直接比较了两种不同干预措施与常规护理的有效性。这 9 项研究中的 6 项表明总体入院率降低了 27%-40%。两项两臂研究表明 HF 相关入院率降低了 40%-46%，而另外两项三臂研究显示出类似的趋势；然而，这在统计学上并不显著。这 9 项研究中有 3 项表明死亡率（30%-67%）显著降低，有 3 项研究表明医疗保健利用成本显著降低。两项研究表明护理床日减少了 53%-62%。两项研究表明急诊就诊次数显著减少。三项两臂研究和一项三臂研究表明，使用远程监测可显著改善整体预后。现有数据表明远程监测是一种有前途的策略。需要更多的数据来确定理想的患者人群、技术和参数、远程监测的频率和持续时间，以及病例管理和密切监测的精确组合，以确保 HF 患者的结果一致改善，并降低成本。
