Abstract 3896: Remote Monitoring of Heart Failure Patients Reduces the Clinical and Economic Burden of Disease: A Metanalysis of Clinical Trials and Cohort Studies
Remote patient (pts) monitoring (RPM) via regular structured telephone contacts between pts and healthcare providers or electronic transfer of physiological data using remote access technology is a growing modality to manage patients with chronic heart failure (HF). We assessed the hypothesis that RPM reduces both the clinical and economical burden of disease in chronic HF pts. After review of the literature published between January 2000 and October 2008 on multidisciplinary heart failure approach either by usual care (in-person visit) or by RPM, 96 full texts articles were retrieved; 21 articles reporting about randomized controlled trials (RCTs) and 6 about cohort (C) studies with between design qualified for a meta-analysis. Considered outcomes for assessing the clinical burden were overall mortality and number of hospitalized pts for any cause and for HF; outcomed for assessing the economic burden were total number of hospitalizations and length of stay (LOS). Study relative risks (RR) and mean LOS were pooled according to the Mantel-Haenszel’s fixed effects or the DerSimonian and Laird random effects models. 6308 (36% female) and 1925 pts (38% female) were included in RCT and C studies, respectively. Mean age in studies ranged from 45 to 78 and 61 to 81 years, respectively. Both RCTs and C studies showed that RPM was associated with a significantly lower number of deaths (RCTs: RR 0,83; 95%CI 0.73– 0.95, C: RR 0.53; 0.29 – 0.96), pts hospitalized (RCTs: RR=0.93; 0.87– 0.99, C: RR 0.52, 0.28 – 0.96), and pts hospitalized for HF (RCTs: RR: 0.71; 0.64 – 0.80). RPM was associated with a significantly lower total number of hospitalizations per patient (RCTs: RR 0.88; 0.79 – 0.98, C:RR 0.51 0.28 – 0.92) and a significantly shorter LOS (RCT: mean 7.3, range 2.7–13.3 vs 9.0, 4.7–16.7; standardized mean difference −0.14; −0.26 to −0.02). In conclusion, RPM appears to influence both the clinical and economic burden of disease in HF pts, by reducing mortality, number of pts hospitalized, the total number of hospitalizations and LOS.