Parente Hilson A, Hornemann Sophie B, Faria Ismael Mm de, Salgado Diamantino R, Correia Marcelo G, Azevedo Fabiula S de
National Institute of Cardiology, Rio de Janeiro, Brazil.
Barra D'or Hospital, Rio de Janeiro, Brazil.
J Telemed Telecare. 2024 Dec 15:1357633X241299156. doi: 10.1177/1357633X241299156.
To assess whether telemonitoring improves outcomes in patients with chronic heart failure.
A literature search was conducted on studies of randomized controlled trials involving non-invasive telemonitoring and heart failure using Medline, Embase, and Cochrane Library. The primary outcomes were all-cause mortality, all-cause hospitalization, and hospitalization for heart failure. Secondary outcomes were length of stay, health-related quality of life as assessed by validated questionnaires, healthcare costs and cost-effectiveness, and self-care behaviors. We performed a meta-analysis using a random effects model for the primary outcomes. The effect measure was odds ratio with corresponding 95% confidence interval, and heterogeneity among studies was assessed using the Higgins I value. We screened 212 references, and 34 randomized controlled trials were included in this review. A total of 16179 participants with heart failure were included. Non-invasive telemonitoring reduced all-cause mortality by 18% (OR 0.82, 95% CI 0.71 to 0.95; participants = 15,211; studies = 28; I= 34%; GRADE: moderate-quality evidence) and heart failure hospitalization by 20% (OR 0.80, 95% CI 0.69 to 0.94; participants = 7491; studies = 18; I= 31%; GRADE: moderate-quality evidence). Non-invasive telemonitoring didn't demonstrate significant benefit on all-cause hospitalization (OR 0.93, 95% CI 0.82 to 1.05; participants = 11,565; studies = 25; I= 49%).
Telemonitoring programs in patients with heart failure were associated with a reduction in all-cause mortality and heart failure hospitalization without harmful events.
评估远程监测是否能改善慢性心力衰竭患者的预后。
使用Medline、Embase和Cochrane图书馆对涉及非侵入性远程监测和心力衰竭的随机对照试验研究进行文献检索。主要结局为全因死亡率、全因住院率和心力衰竭住院率。次要结局为住院时间、通过有效问卷评估的健康相关生活质量、医疗费用和成本效益以及自我护理行为。我们对主要结局采用随机效应模型进行荟萃分析。效应量为比值比及相应的95%置信区间，使用Higgins I值评估研究间的异质性。我们筛选了212篇参考文献，本综述纳入了34项随机对照试验。共纳入16179例心力衰竭患者。非侵入性远程监测使全因死亡率降低了18%（比值比0.82，95%置信区间0.71至0.95；参与者 = 15211；研究 = 28；I = 34%；证据质量等级：中等质量证据），心力衰竭住院率降低了20%（比值比0.80，95%置信区间0.69至0.94；参与者 = 7491；研究 = 18；I = 31%；证据质量等级：中等质量证据）。非侵入性远程监测在全因住院方面未显示出显著益处（比值比0.93，95%置信区间0.82至1.05；参与者 = 11565；研究 = 25；I = 49%）。
心力衰竭患者的远程监测项目与全因死亡率和心力衰竭住院率的降低相关，且无不良事件发生。
