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Effect of telemonitoring of cardiac implantable electronic devices on healthcare utilization: a meta‐analysis of randomized controlled trials in patients with heart failure
Author(s) -
Klersy Catherine,
Boriani Giuseppe,
De Silvestri Annalisa,
Mairesse Georges H.,
Braunschweig Frieder,
Scotti Valeria,
Balduini Anna,
Cowie Martin R.,
Leyva Francisco
Publication year - 2016
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1002/ejhf.470
Subject(s) - medicine , interquartile range , confidence interval , relative risk , heart failure , randomized controlled trial , emergency medicine , meta analysis , emergency department , psychiatry
Aims Implantable device telemonitoring ( DTM ) is a diagnostic adjunct to traditional face‐to‐face hospital visits. Remote device follow‐up and earlier diagnoses facilitated by DTM should reduce healthcare utilization. We explored whether DTM reduces healthcare utilization over standard of care ( SoC ), without compromising patient outcomes. Methods and results This systematic review and meta‐analysis of 11 randomized controlled trials on DTM in patients with heart failure consisted of 5702 patients, with a median of 117 [interquartile range ( IQR ) 76–331] patients per study [age 65 years ( IQR 63–67)] and follow‐up range of 12–36 months. DTM was associated with a reduction in total number of visits [planned, unplanned, and emergency room ( ER )] [relative risk ( RR ) 0.56; 95% confidence interval ( CI ) 0.43–0.73, P < 0.001]. Rates of cardiac hospitalizations ( RR 0.96; 95% CI 0.82–1.12, P = 0.60) and the composite endpoints of ER , unplanned hospital visits, or hospitalizations ( RR 0.99; 95% CI 0.68–1.43, P = 0.96) was similar between the DTM and the SoC groups. An increase in the total number of ER or unscheduled visits ( RR 1.37; 95% CI 1.11–1.70, P = 0.004) was observed. This effect was consistent and statistically significant for all studies. Total and cardiac mortality were similar between the groups ( DTM RR 0.90; 95% CI 0.69–1.16, P = 0.41; and DTM RR 0.93; 95% CI 0.51–1.69, P = 0.80). Monetary costs favoured DTM (10–55% reduction in five studies). Conclusions Compared with SoC , DTM is associated with a marked reduction in planned hospital visits. In addition, DTM was associated with lower monetary costs, despite a modest increase in unplanned hospital and ER visits. DTM did not compromise survival.