Table 1
Search queries of this systematic review.
| DATABASE | SEARCH QUERY | INITIAL HITS |
|---|---|---|
| PubMed | (((((HFrEF) OR (heart failure)) OR (congestive heart failure)) AND (((((((((telemedicine) OR (online follow up)) OR (telecardiology)) OR (ehealth)) OR (e-health)) OR (online consultation)) OR (telehealth)) OR (virtual care)) OR (telemonitoring))) AND (((outpatient visitation) OR (offline follow up)) OR (in person appointment))) AND (((((((((Minnesota living with heart failure questionnaire) OR (quality of life)) OR (hospitalisation rate)) OR (hospitalisation)) OR (inpatient admission)) OR (admission rate)) OR (mortality)) OR (death)) OR (survival rate)) | 68 |
| Medline | (((Heart Failure or CHF or HF or Congestive Heart Failure).mp. [mp = title, abstract, original title, name of substance word, subject heading word, floating sub-heading word, keyword heading word, organism supplementary concept word, protocol supplementary concept word, rare disease supplementary concept word, unique identifier, synonyms]) OR (Heart Failure.mp. or exp Heart Failure/) OR (HFrEF.mp.) OR (Congestive Heart Failure.mp.)) AND (((Online follow-up or telemedicine or online consultation or eHealth or telehealth or e-Health or telecardiology).mp. [mp = title, abstract, original title, name of substance word, subject heading word, floating sub-heading word, keyword heading word, organism supplementary concept word, protocol supplementary concept word, rare disease supplementary concept word, unique identifier, synonyms]) OR (Telemedicine.mp. or exp Telemedicine/)) AND (((Offline follow-up or Outpatient visitation or in-person appointment).mp. [mp = title, abstract, original title, name of substance word, subject heading word, floating sub-heading word, keyword heading word, organism supplementary concept word, protocol supplementary concept word, rare disease supplementary concept word, unique identifier, synonyms]) OR (Outpatient Visitation.mp. or exp Ambulatory Care/)) AND ((quality of life.mp. or exp “Quality of Life”/) OR (hospitalisation.mp. or exp hospitalisation/) OR (Admission Rate.mp. or exp Patient Admission/) OR (exp Mortality/or Mortality.mp.) OR (Survival rate.mp. or exp Survival Rate/) OR ((Quality of Life or QoL or hospitalisation or Inpatient admission or Admission Rate or hospitalisation rate or Mortality or Death or Survival rate).mp. [mp = title, abstract, original title, name of substance word, subject heading word, floating sub-heading word, keyword heading word, organism supplementary concept word, protocol supplementary concept word, rare disease supplementary concept word, unique identifier, synonyms]) OR (Death.mp. or exp Death/)) | 24 |
| EMBASE | ((heart failure OR congestive heart failure) AND (follow up OR online system OR telemedicine OR consultation OR teleconsultation OR telehealth OR telecardiology) AND (outpatient OR outpatient care OR outpatient department) AND (quality of life OR questionnaire OR hospitalisation OR hospital admission OR hospital mortality OR mortality rate OR mortality OR cardiovascular mortality OR survival rate)) | 180 |
| SCOPUS | ( TITLE-ABS-KEY ( ( heart AND failure ) ) OR TITLE-ABS-KEY ( ( hf ) ) OR TITLE-ABS-KEY ( ( congestive AND heart AND failure ) ) OR TITLE-ABS-KEY ( ( chf ) ) OR TITLE-ABS-KEY ( ( hfref ) ) AND TITLE-ABS-KEY ( ( telemedicine ) ) OR TITLE-ABS-KEY ( ( online AND follow-up ) ) OR TITLE-ABS-KEY ( ( online AND consultation ) ) OR TITLE-ABS-KEY ( ( ehealth ) ) OR TITLE-ABS-KEY ( ( telehealth ) ) OR TITLE-ABS-KEY ( ( e-health ) ) OR TITLE-ABS-KEY ( ( telecardiology ) ) OR TITLE-ABS-KEY ( ( virtual AND care ) ) OR TITLE-ABS-KEY ( ( telemonitoring ) ) AND TITLE-ABS-KEY ( ( outpatient AND visitation ) ) OR TITLE-ABS-KEY ( ( offline AND follow-up ) ) OR TITLE-ABS-KEY ( ( in AND person AND appointment ) ) AND TITLE-ABS-KEY ( ( minnesota AND living AND with AND heart AND failure AND questionnaire ) ) OR TITLE-ABS-KEY ( ( mlhfq ) ) OR TITLE-ABS-KEY ( ( quality AND of AND life ) ) OR TITLE-ABS-KEY ( ( qol ) ) OR TITLE-ABS-KEY ( ( hospitalisation ) ) OR TITLE-ABS-KEY ( ( inpatient AND admission ) ) OR TITLE-ABS-KEY ( ( admission AND rate ) ) OR TITLE-ABS-KEY ( ( mortality ) ) OR TITLE-ABS-KEY ( ( death ) ) OR TITLE-ABS-KEY ( ( survival AND rate ) ) | 3 |
| Cochrane Central Database | #1 MeSH descriptor: [Heart Failure] explode all trees #2 “Heart Failure” OR HF OR “Congestive Heart Failure” OR CHF OR HFrEF #3 MeSH descriptor: [Telemedicine] explode all trees #4 Telemedicine OR “Online follow-up” OR “online consultation” OR eHealth OR telehealth OR e-Health OR telecardiology #5 MeSH descriptor: [Outpatients] explode all trees #6 Outpatient OR “Outpatient visitation” OR “offline follow-up” OR “in person appointment” #7 “Quality of life” OR QoL OR “Minnesota Living with Heart Failure Questionnaire” OR MLHFQ OR hospitalisation OR hospitalisation OR “inpatient admission” OR “admission rate” OR mortality OR death OR “survival rate” #8 #1 OR #2 #9 #3 OR #4 #10 #5 OR #6 #11 #7 AND #8 AND #9 AND #10 | 94 |
Figure 1
The PRISMA flow diagram for the systematic review.
Table 2
Summary of study characteristics and population demographics of systematic reviews.
| AUTHORS | YEAR PUBLI-SHED | STUDY TYPE | STUDY LOCATION | STUDY DURATION | SAMPLE CHARACTERISTICS | TYPES OF INTERVENTION | ||||
|---|---|---|---|---|---|---|---|---|---|---|
| MEAN/MEDIAN AGE (YEARS) | SAMPLE SIZE | MALE/FEMALE (%) | NYHA CLASS | LVEF (%) | ||||||
| Inglis et al. | 2015 | Systematic review and meta-analysis | STS: USA 14), Australia (1), Argentina (1), Brazil (1), Canada (1), Germany (1), India (1), Iran (1), Italy (1) and two studies which were involved several European countries (Germany, Netherlands, UK, Poland, Italy). HT: Italy (3), USA (3), Canada (2), Austria (1), Belgium (1), Finland (1), France (1), Germany (1), Sweden (1), The Netherlands (1), UK (1) and two studies involved several European countries (Germany, The Netherlands and the UK; UK, Poland and Italy) | 6 months | STS = 45–75 HT = 55–78 | 41 studies STS = 9332 HT = 3860 | STS = 64/36 HT = 72/28 | STS = II–III HT = III | N/A | Structured telephone support or non-invasive home telemonitoring compared with usual post-discharge care |
| Allida et al. | 2020 | Systematic review | Australia (1), China (1), Iran (1), Sweden (1), and The Netherlands (1) | 1–12 months | 60–75 | 5 studies 1010 | 63/37 | II–III | N/A | mHealth-delivered education interventions |
[i] Abbreviations: NYHA, New York heart association; LVEF, left ventricle ejection fraction; USA, United States of America; UK, United Kingdom; STS, structured telephone support; HT, non-invasive home telemonitoring; PDA, personal digital assistant; RTM, remote telemedical management N/A, not available/not known/not mentioned.
Table 3
Summary of study characteristics and population demographics of randomised control trials.
| AUTHORS | YEAR PUBLISHED | STUDY TYPE | STUDY LOCATION | STUDY DURATION | SAMPLE CHARACTERISTICS | ||||
|---|---|---|---|---|---|---|---|---|---|
| MEAN/MEDIAN AGE (YEARS) | SAMPLE SIZE | MALE/FEMALE (%) | NYHA CLASS | LVEF (%) | |||||
| Villani et al. | 2014 | RCT | Italy | 12 months | 72 | 81 | Integrated management 75/25 Usual care: 73/27 | III–IV | Mean LVEF 32 (5) |
| Pedone et al. | 2015 | RCT | Italy | 6 months | 80 | 90 | Telemonitoring 47/53 Control 30/70 | II–IV | N/A |
| Kenealy et al. | 2015 | RCT | New Zealand | 6 months | 72 | 98 | Telecare 61/39 Usual care 71/29 | III–IV | N/A |
| Pekmezaris et al. | 2019 | RCT | USA | 3 months | 59.9 | 104 | 57/43 | II–III | 61% had reduced EF <40% |
| Riegel B et al. | 2002 | RCT | USA | 6 months | 72 (12) | 358 | Telemedicine 54/46 Usual care 47/59 | II–IV | Mean LVEF 41.9 (17.0) |
| Benatar D et al. | 2003 | RCT | USA | 12 months | 63 (12) | 216 | NTM 64/36 HNV 38/62 | III–IV | NTM 38.05 (13.70) vs HNV 38.83 (13.97) |
| Dar O et al. | 2009 | RCT | UK | 6 months | 72 (12) | 182 | Telemonitoring 68/34 Usual care 65/35 | II–IV | Mean LVEF was not reported 39% had LVEF >40% |
| Koehler F et al. | 2011 | RCT | Germany | 24 months | 66.9 (10.8) | 710 | RTM 81/19 Usual care 82/18 | II–III | Criteria LVEF <35% Mean LVEF 26.9 (5.7) vs 27.0 (5.9) |
| Jerant AF et al. | 2001 | RCT | USA | 6 months | Video-based telecare 66.6 (10.9) Group telephone 71.3 (14.1) Usual care 72.7 (11.4) | 37 | Video-based telecare 46/54 Group telephone 42/58 Usual care 50/50 | II–IV | N/A |
| Kurtz B et al. | 2011 | RCT | France | 12 months | 68 (11) | 138 | Telemonitoring 83/17 HF clinic 86/14 Usual care 75/25 | II–IV | Criteria LVEF <45% Mean LVEF 32 (10) vs 30 (8) vs 32 (8) |
| Melin M et al. | 2018 | RCT | Sweden | 6 months | 75(8) | 72 | Intervention group 66/34 Control group 70/30 | II–IV | Mean LVEF was not reported 36% had HFpEF 54% had HFrEF |
| Antonicelli R et al. | 2008 | RCT | Italy | 12 months | 78.2 (7.3) | 57 | HT 57/43 CG 66/34 | II–IV | Criteria LVEF <40% Mean LVEF HT 35 (6) vs CG 37(7) |
| Baker DW et al. | 2011 | RCT | USA (4 different sites) | 12 months | 60.7(13.1) | 605 | BEI 52/48 TTG 52/48 | II–IV | Mean LVEF was not reported, but 60% had LVEF <45% |
| Blum K et al. | 2014 | RCT | USA | 48 months | Monitor group 73 ± 8 Usual care 72 ± 10 | 206 | MG 70.30 UC 72/28 | II–IV | Mean LVEF MG 29 ± 15 UC 29 ± 15 |
| DeWalt DA et al. | 2006 | RCT | USA | 12 months | Intervention group 63 ± 9 Control group 62 ± 11 | 123 | IG 58/42 CG 55/45 | II–IV | Criteria LVEF < 40% Mean LVEF 39% vs 44% |
| Ferrante D et al. | 2010 | RCT | Buenos Aires, Argentina | 36 Months | IG (n = 760) 64.8 (13.9) CG (n = 758) 65.2 (12.7) | 1,518 | IG 72.6/27.4 CG 68.9/31.1 | II–IV | Mean LVEF was not reported, but 80% had LVEF <40% |
| Goldberg LR et al. | 2003 | RCT | Multiple centres in United States | 6 Months | Intervention group (n = 138) 57.9 (15.7) Standard care (n = 142)60.2 (14.9) | 280 | IG 69.6/30.4 CG 65.5/34.5 | III–IV | Criteria LVEF <35% IG 21.6 (6.8) CG 21.8 (6.8) |
| Mizukawa M et al. | 2019 | RCT | Hiroshima, Japan | 24 Months | Usual Care 74.5 (12.1) Self-Management 69.4 (12.9) Collaborative management 70.5(13.3) | 60 | Usual Care 52.6/48.4 Self-Management Male (n = 15) 83.3/16.7 Collaborative management 50/50 | III–IV | Criteria LVEF <40% or >40% Usual Care 42.1 (16.5) Self-Management 42 (14.7) Collaborative management 42.2 (16.7) |
| Krum H et al. | 2012 | RCT | Australia | 12 Months | Usual Care (n = 217) 73 (11) Usual Care + Intervention (n = 188) 73 (10) | 405 | Usual Care 54/36 Usual Care + Intervention 52/38 | II–IV | Criteria LVEF <40% Usual Care 34.9 (23.5) Usual Care + Intervention 37.2 (14.1) |
| Lynga P et al. | 2012 | RCT | Sweden | 12 months | 73 | 319 | Control: 74/26 Intervention: 76/24 | III–IV | Criteria LVEF <50% 57% had LVEF <30% |
| Mortara A et al. | 2008 | RCT | United Kingdom, Poland, Italy | 12 months | 60 ± 11 | 461 | Control: 83/17 Intervention: 86/14 | II–IV | Criteria LVEF <40% Mean LVEF 29 (7) |
| Seto E et al. | 2012 | RCT | Canada | 6 months | 55.1 (13.7) | 100 | Control: 76/24 Intervention: 82/18 | II–IV | Criteria LVEF <40% |
| Soran OZ et al. | 2008 | RCT | USA (3 distinct medical centres) | 6 months | Alere 76.9(7.1) Standard care 76(6.8) | 315 | Alere 31/69 SC 61/39 | II–III | Criteria LVEF <40% Alere 24.3(8.8) SC 23.8(8.7) |
| Wakefield BJ et al. | 2007 | RCT | USA | 12 months | 69.3 (9.6) | 148 | Videophone 88/12 Telephone 94/6 Usual care 100/0 | II–IV | Mean LVEF 41.4% (Range 6–81%) |
| Woodend AK et al. | 2008 | RCT | Canada | 3 months | 68 | 121 | Telehome 74/27 Usual care 70/30 | II–IV | N/A |
[i] Abbreviations: RCT, randomised controlled trial; NYHA, New York heart association; LVEF, left ventricle ejection fraction; USA, United States of America; UK, United Kingdom; PDA, personal digital assistant; RTM, remote telemedical management; NTM, nurse telemonitoring; HNV, home nurse visit; MG, monitored group; SC, standard care; N/A, not available/not known/not mentioned.
Table 4
Description of intervention in randomised clinical trials.
| AUTHOR | TYPES OF INTERVENTION |
|---|---|
| Villani et al. | Telemonitoring using a handheld PDA connected with the monitoring center |
| Pedone et al. | Telemonitoring system that receives oxygen saturation, heart rate, and blood pressure readings with telephone support |
| Kenealy et al. | Using a small device to measure and input data daily (include weight, blood pressure, and oxygen level) compared with usual care |
| Pekmezaris et al. | Tailored telehealth self-monitoring (consists of daily vital signs monitoring and weekly video visit) compared with comprehensive outpatient management |
| Riegel B et al. | Telephonic case-management and use of software programs to identify important clinical data such as patients’ worsening of symptoms, knowledge and medical needs. |
| Benatar D et al. | Transtelephonic home monitoring devices to measure vital signs. Nurse evaluates objective data and conducts telephone assessments, titrates medication therapy and educates patients |
| Dar O et al. | Daily telemonitoring of signs and symptoms (e-weigh scale, automated blood pressure cuff, pulse oximeter, and a control box connected to phone line. Data were reviewed on a daily basis by a HF nurse. Any abnormal results alert the health personnel who would call the patients for further assessment and medical advice |
| Koehler F et al. | Patients were provided with telehealth patient station in their home. Weekly virtual nursing visits and monitoring of symptoms and vital signs on daily basis. |
| Jerant AF et al. | Scheduled phone call from study nurse and video-based telecare |
| Kurtz B et al. | Automated home-based self-monitoring using conventional telephone weekly. The algorithm is able to advise patients medically based on their symptoms. Patients are scheduled for three visits to the clinic in a year. |
| Melin M et al. | Utilised telemonitoring system. E-weighing scale is connected to OPTILOGG system (tablet computer and custom software), which also contains education module about HF and patients are instructed to input their symptoms every 5 days |
| Antonicelli R et al. | Telephone support system weekly by HF team to collect information on vital blood signs, urine output and body weight, as well as symptoms and treatment adherence. A weekly ECG was also recorded. Patients and caregivers underwent training courses to apply the home study protocol and correct use of equipment. Therapeutic regimen was regularly assessed and altered as necessary based on telemonitored data or telephone interviews. |
| Baker DW et al. | Daily weighing to guide diuretic self-adjustment, including an individualized pain developed with the patient clinicians. Symptoms monitoring, intensive education and self-care training through 5–8 follow up phone calls in a month. |
| Blum K et al. | Remote monitoring of daily weights, blood pressure, heart rate and 15-second heart rhythm strip using Phillips Electronics E-care System. Data was then transmitted wirelessly and compared to individually assigned parameters based on subjects’ admission and evaluations. Any needed adjustments including medication dosage and/or any readings outside of the normal parameter was then done by a nurse practitioner. |
| DeWalt DA et al. | Structured telephone support through scheduled follow-up phone calls (day 3, 7 and every 7 days, and monthly during months 3–6) preceded by educational session and allotment of educational booklets with clinical pharmacist or health educator regarding signs of HF exacerbation, daily weight assessment and diuretic dose adjustment. Phone calls were done to reinforce these educational points. |
| Ferrante D et al. | Patients were followed up with a telephone intervention by specialised nurses. Patients were initially called every 14 days and then adjusted according to the severity of each patient. Nurses were allowed to adjust short-term changes in diuretics and to suggest unscheduled visits to the attending cardiologist. Control group continued treatment with their cardiologist in the same manner as the intervention group. |
| Goldberg LR et al. | Patients in the intervention group received continued standard outpatient heart failure therapy plus AlereNet system or standard outpatient heart failure therapy. The AlereNet system includes an electronic scale and an individualised symptom response system (DayLink monitor) linked via a standard phone line to a computerized database monitored by trained cardiac nurses. Patients were instructed to weigh themselves and respond to yes/no questions about HF symptoms twice daily. The nurses contacted the patient as necessary to verify any changes observed in symptoms or weight. |
| Mizukawa M et al. | Patients in all groups were provided with a notebook to record daily self-monitoring data such as weight, blood pressure, and pulse. Patients in the usual care group received one standard education session at enrollment using a pre-existing booklet and received HF treatment provided by their physician. Patients in the intervention groups (self-management and collaborative management) received disease management programs for 12 months. In addition, patients in the CM group received telemonitoring intervention, in which a nurse checked data and called patients as needed for 12 months. Each patient received noninvasive physiologic telemonitoring devices to measure BP, pulse rate, and body weight daily. The data were transmitted to the nurse’s computer and checked daily by trained nurses. The nurses also arranged physician visits or contacted the patient care manager for care coordination as needed. |
| Krum H et al. | Usual care involved standard general practice management of heart failure according to the National Heart Foundation of Australia/Cardiac Society of Australia and New Zealand Heart Failure Management Guidelines. In addition to UC, the UC plus intervention group received ongoing support by touchtone telephone using the TeleWatch system. This telemedicine system was required to be dialled into by the patient on a monthly basis at which time questions were asked with regard to heart failure clinical status by heart failure specialist nurses. In addition, the patients were able at any time to dial to the system and receive advice about management of their heart failure symptoms or be directed to a general practitioner or an emergency department. Patient information resource, regular newsletters, and an individualised patient diary were also provided for the intervention group. |
| Lynga P et al. | Telemonitoring using an electronic scale (Zenicor Medical Systems AB) installed in the patient’s home. Quote, “…after weighing, a wireless signal was sent from the scale to a modem plugged into the patient’s telephone. The weight was then automatically transmitted via the telephone network to a central internet-based data server system (Zenicor Medical Systems AB). Hence, the weight could be checked from any computer with internet access. The system sounds an alarm if the patient gains > 2 kg from the target weight and if there is an increase of > 2 kg in 3 days. |
| Mortara A et al. | Home telemonitoring using a cardiorespiratory recorder and modem, digital blood pressure monitor (UA-767, A&D Company, Tokyo, Japan), and electronic weighing scale. Patients were randomized into usual care and three home telemonitoring groups: (i) monthly telephone contact; (ii) strategy 1 plus weekly transmission of vital signs; and (iii) strategy 2 plus monthly 24 h recording of cardiorespiratory activity. |
| Seto E et al. | Telemonitoring of body weight and blood pressure (UA UC-321PBT weight scale and UA-767PBT blood pressure monitor, A&D Medical, USA) and ECG recordings (SelfCheck ECG PMP4, CardGuard, Israel) were automatically sent wirelessly to a mobile phone (BlackBerry Pearl 8130, Research in Motion, Canada) via Bluetooth before being transmitted to the data center at the hospital. The cardiologist would call the patients once alerted by abnormal data |
| Soran OZ et al. | Home-based disease management program (Alere DayLink HF Monitoring System, HFMS) detects early signs and symptoms of HF linked to a standard phone line and into a computerized database run by trained nurses. Patients were instructed to weigh themselves and respond to HF symptoms questions daily. Transmitted data were reviewed daily, and patients were contacted to verify changes in observed symptoms and/or weight. Significant changes in symptoms and/or weight were alerted to attending physicians who then adjust therapeutic changes and/or schedule patient visits accordingly. |
| Wakefield BJ et al. | Telephone or videophone interviews were conducted weekly by a nurse to assess patients’ reported HF-related symptoms, body weight, blood pressure, ankle circumference that were measured by the patients. Additionally, patients underwent behaviour skill training to optimise self-management, self-monitoring and self-efficacy |
| Wooden AK et al. | Home-monitoring equipment was installed in the patient’s home. Patients were instructed to measure body weight and blood pressure daily and data will be transmitted to a central station/The 12-lead ECG was also recorded periodically. Video conference with a nurse was conducted weekly to review the patient’s progress and self-care education |
Table 5
Critical appraisal for systematic reviews using AMSTAR 2 checklist.
| SYSTEMATIC REVIEWS | AMSTAR 2 ITEMS | QUALITY OF REVIEW | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13 | 14 | 15 | 16 | ||
| Inglis et al. | Y | Y | Y | PY | Y | Y | Y | Y | Y | Y | Y | Y | N | Y | Y | Y | Low |
| Allida et al. | Y | Y | N | PY | Y | Y | Y | Y | Y | Y | Y | Y | N | Y | Y | N | Low |
[i] Abbreviations: Y, Yes; PY, Partial Yes; N, No.
Table 6
Critical appraisal for RCTs using PEDro scale.
| RCTS | PEDRO SCALE ITEMS | TOTAL SCORE | QUALITY | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ELIGIBILITY | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | |||
| Villani et al. | Yes | 1 | 0 | 1 | 0 | 0 | 0 | 1 | 1 | 1 | 0 | 5/10 | Fair |
| Pedone et al. | Yes | 1 | 1 | 1 | 0 | 1 | 0 | 1 | 0 | 1 | 1 | 7/10 | Good |
| Kenealy et al. | Yes | 1 | 1 | 1 | 0 | 0 | 0 | 1 | 1 | 1 | 1 | 7/10 | Good |
| Pekmezaris et al. | Yes | 1 | 1 | 1 | 0 | 0 | 0 | 1 | 1 | 1 | 1 | 7/10 | Good |
| Riegel B et al. | Yes | 1 | 1 | 1 | 0 | 1 | 0 | 1 | 1 | 1 | 1 | 8/10 | Good |
| Benatar D et al. | Yes | 1 | 0 | 1 | 0 | 0 | 0 | 1 | 1 | 1 | 1 | 6/10 | Good |
| Dar O et al. | Yes | 1 | 0 | 1 | 0 | 0 | 1 | 1 | 1 | 1 | 1 | 7/10 | Good |
| Koehler F et al. | Yes | 1 | 0 | 1 | 0 | 0 | 1 | 0 | 1 | 1 | 1 | 6/10 | Good |
| Jerant AF et al. | Yes | 1 | 1 | 1 | 0 | 0 | 1 | 1 | 1 | 1 | 1 | 8/10 | Good |
| Kurtz B et al. | Yes | 0 | 0 | 0 | 0 | 0 | 0 | 1 | 1 | 1 | 1 | 4/10 | Fair |
| Melin M et al | Yes | 1 | 0 | 1 | 0 | 0 | 1 | 0 | 1 | 1 | 1 | 6/10 | Good |
| Antonicelli R et al | Yes | 1 | 0 | 1 | 0 | 0 | 0 | 1 | 1 | 1 | 1 | 6/10 | Good |
| Baker DW et al | Yes | 1 | 0 | 1 | 0 | 0 | 1 | 1 | 0 | 1 | 1 | 6/10 | Good |
| Blum K et al | Yes | 1 | 1 | 0 | 1 | 0 | 0 | 0 | 1 | 1 | 1 | 6/10 | Good |
| DeWalt DA et al | Yes | 1 | 1 | 1 | 1 | 0 | 0 | 0 | 1 | 1 | 1 | 7/10 | Good |
| Ferrante D et al | Yes | 1 | 0 | 1 | 0 | 0 | 0 | 1 | 1 | 1 | 1 | 6/10 | Good |
| Goldberg LR et al | Yes | 1 | 0 | 1 | 0 | 0 | 1 | 1 | 1 | 1 | 1 | 7/10 | Good |
| Mizukawa M et al | Yes | 1 | 0 | 1 | 0 | 0 | 0 | 1 | 1 | 1 | 1 | 6/10 | Good |
| Krum H et al | Yes | 1 | 0 | 1 | 0 | 0 | 1 | 1 | 1 | 1 | 1 | 7/10 | Good |
| Lynga P et al | Yes | 1 | 0 | 1 | 0 | 0 | 0 | 1 | 1 | 1 | 1 | 6/10 | Good |
| Mortara A et al | Yes | 1 | 1 | 1 | 0 | 0 | 1 | 1 | 0 | 1 | 1 | 7/10 | Good |
| Seto E et al | Yes | 1 | 1 | 1 | 0 | 0 | 0 | 1 | 0 | 1 | 1 | 6/10 | Good |
| Soran OZ et al | Yes | 1 | 1 | 0 | 1 | 0 | 0 | 1 | 1 | 1 | 1 | 7/10 | Good |
| Wakefield BJ et al | Yes | 1 | 0 | 1 | 0 | 0 | 0 | 0 | 1 | 1 | 1 | 5/10 | Fair |
| Wooden AK et al | Yes | 1 | 0 | 1 | 0 | 0 | 0 | 1 | 1 | 1 | 1 | 6/10 | Good |
Table 7
Results of the systematic review included in the study.
| STUDIES | STUDY RESULTS | |||
|---|---|---|---|---|
| MORTALITY | HR-QOL | ALL-CAUSE HOSPITALISATION | HF-RELATED HOSPITALISATION | |
| Inglis et al. | STS RR 0.87 (95% CI 0.77–0.98); I2 = 0% HT RR 0.80 (95% CI 0.69–0.94); I2 = 24% | N/A | STS RR 0.95 (95% CI 0.90–1.00); I2 = 47% HT RR 0.95 (95% CI 0.89–1.01); I2 = 71% | STS RR 0.85 (95%CI 0.77–0.93); I2 = 27% HT RR 0.71 (95%CI 0.60–0.83); I2 = 20% |
| Allida et al. | N/A | MLHFQ MD -0.10 lower in the intervention group (95% CI -2.35 to 2.15); I2 = 61%) | N/A | OR 0.74 (95% CI 0.52–1.06); I2 = 0% |
[i] Abbreviations: HR-QoL, health-related quality of life; STS, structured telephone support; HT, non-invasive home telemonitoring; MLHFQ, Minnesota Living with Heart Failure Questionnaire; RR, relative risk; HR, hazard ratio; CI, confidence interval; OR, odd ratio; N/A, not available.
Table 8
Results of the randomised control trials included in the study.
| STUDIES | STUDY RESULTS | |||
|---|---|---|---|---|
| MORTALITY | HR-QOL | ALL-CAUSE HOSPITALIZATION | HF-RELATED HOSPITALIZATION | |
| Villani et al. | RR 0.56 (95%CI 0.20–1.51), 5/40 vs 9/40,p > 0.05 at 1-year follow-up | N/A | N/A | RR 0.52 (95%CI 0.30–0.89) 12/40 vs 23/40, p < 0.03, at one-year of follow up |
| Pedone et al. | RR 0.51 (95% CI 0.26–0.98) at 6-month follow-up | N/A | RR 0.30 (95% CI 0.12–0.67) at 6-month follow-up | RR 0.48 (95% CI 0.14–1.45) at 6-month follow-up |
| Kenealy et al. | RR 0.63 (95%CI 0.21–1.82) at 6-month follow-up | Coefficient of interaction (telecare vs usual care) of 0.47 (p = 0.63) after 6 months of follow up using the SF-36 (Mental component score) | 95 vs 63 (p-value unavailable) at 6-month follow-up | N/A |
| Pekmezaris et al. | N/A | TSM: 62.7 at baseline and 36.3 after 90 days vs COM: 59.9 at baseline and 27.8 after 90 days, p = 0.50 using MLHFQ | Binary analysis: RR 0.92 (95% CI 0.57–1.48, p = 0.73) during 90 days of follow up; Non-binary analysis mean (62): 0.78 (1.3) TSM vs 0.55 (0.9) COM, p = 0.03 | Binary analysis: RR 1.27 (95% CI 0.44–3.6, p = 0.65) during 90 days of follow up; Non-binary analysis mean (62): 0.15 (0.47) TSM vs 0.16 (0.41) COM, p = 0.76 |
| Riegel B et al. | N/A | N/A | Telemedicine 0.45(0.73) vs usual care 0.61(0.88) at 3-month follow-up, p = 0.09; Telemedicine 0.62(0.88) vs usual care 0.87(1.1) at 6-month follow-up, p = 0.03 | Telemedicine 0.17 (0.43) vs usual care 0.31(0.64) at 3-month follow-up, p = 0.03; Telemedicine 0.21(0.5) vs usual care 0.4(0.77) at 6-month follow-up, p = 0.01 |
| Benatar D et al. | N/A | MLHFQ Pre vs post intervention HT group: 77.92 (10.30) vs 51.64(17.36), p < 0.01 Pre vs post intervention home nurse visit: 77.1(8.52) vs 57.72 (16.24), p < 0.01 Between-group p = 0.98 | 13 vs 24, p ⩽ 0.001 at 3-month follow-up 38 vs 63, p ⩽ 0.05 at 6-month follow-up 75 vs 103, p = 0.12 at one-year follow-up | N/A |
| Dar O et al. | N/A | N/A | 36 % vs 81% (p = 0.01) at 6-month follow-up | N/A |
| Koehler F et al. | HR 0.97 (95% CI 0.67–1.41), p = 0.87 | SF-36 (physical functioning) mean score (46) 54.3 (1.2) vs 49.9 (1.2), p = 0.01 after 12 months | N/A | N/A |
| Jerant AF et al. | N/A | N/A | RR 0.36 (95% CI 0.21–0.62) | N/A |
| Kurtz B et al. | Risk reduction 22% vs 44%, p = 0.04 at one year follow-up | N/A | N/A | |
| Blum K et al. | RR 1.07 (95%CI 0.79–1.44) at 4-years follow-up | MLHFQ Scores improved over the years within UC and MG (p < 0.001), but no difference between UC & MG | RR 1.06 (95%CI 0.90–1.24) | Mean HF hospitalizations per subject MG 2 ± 2 vs. UC 3 ± 3 (p = 0.76) |
| DeWalt DA et al. | RR 0.79 (95% CI 0.18–3.37) | MLHFQ Difference between scores in IG and CG 3.5 points (95% CI -4–11), p = 0.36 | Crude all-cause hospital admission or death IRR 0.69 (95% CI 0.40–1.19) | Unadjusted IRR 0.79 (95% CI 0.42–1.5) |
| Ferrante D et al. | Intervention vs. Control At 1 year: RR 0.94 (0.77–1.16); p = 0.586 At 3 years: RR 1.02 (0.87–1.2); p = 0.73 | Intervention vs. Control MLHFQ Global score: 30.6 vs. 35, p = 0.001 Physical domain: 11.2 vs. 12.8, p –0.007 Emotional domain: 6.7 vs. 7.9, p = 0.002 | N/A | Intervention vs Control At 1 year: 174 (22.9%) vs 220 (29%); RR 0.73 (0.6–0.9); p = 0.002 At 3 years: 217 (28.9%) vs 266 (35.1%); RR 0.72 (0.6–0.87); p = 0.0004 |
| Goldberg LR et al. | Intervention vs Control 11 (8%) vs. 26 (18.4%), number needed to treat 9.7, p < 0.003 RR: 0.43 (95%CI 0.22–0.84); p = 0.0142 | Intervention vs Control MLHFQ (mean ± SD) –27.8 ± 23.8 vs -23.3 ± 26.9, p = 0.22 | Intervention vs Control (mean ± SD) average utilisation per patient per month 0.19 ± 0.46 vs 0.2 ± 0.3, p = 0.28 | Intervention vs Control (mean ± SD) average utilisation per patient per month 0.08 ± 0.24 vs. 0.11 ± 0.26, p = 0.28 |
| Mizukawa M et al. | 15% vs. 15.8% RR: 1.1 (95%CI 0.25–4.83), p = 0.8996 | Using MLHFQ The CM group had better improvement with statistical significance vs UC group at 18 months (p = 0.014) and at 24 months (p = 0.016) vs SM group at 18 months (P = 0.044); vs baseline at 6 months (p = 0.002), 12 months (p = 0.012), 18 months (p = 0.003) and 24 months (p = 0.018) | 60% vs. 68.4% RR: 0.87 (95%CI 0.54–1.40); p = 0.5843 | 20% vs. 57.9% HR: 0.29 (95% CI, 0.09–0.92; p = 0.035) |
| Krum H et al. | Usual Care 16/209 (7.6%) Usual Care + Intervention 17/170 (10%) Unadjusted HR: 1.3 (95%CI 0.65–2.77, p = 0.43) Adjusted HR: 1.36 (95% CI 0.63–2.93, p = 0.439) | N/A | Usual Care 114/204 (55.8%) Usual Care + Intervention 74/161 (45.9%) Unadjusted HR: 0.71 (95%CI 0.53–0.95, p = 0.021) Adjusted HR: 0.67 (95%CI 0.50–0.89, p = 0.006) | Usual Care 35/204 (17.2%) Usual Care + Intervention 23/161 (14.3%) Unadjusted HR: 0.81 (95%CI 0.44–1.38, p = 0.43) Adjusted HR: 0.78 (95%CI 0.45–1.33, p = 0.36) |
| Lynga P et al. | 8/153 vs. 5/166, HR 0.57 [0.19–1.73], p = 0.32 | N/A | 84/153 vs. 79/166, HR 0.83 [0.61–1.13], p = 0.24 | 70/153 vs. 70/166, HR 0.90 [0.65–1.26], p = 0.54 |
| Mortara A et al. | 7/94 vs. 9/160, RR 1.32 (95% CI 0.51–3.44) | N/A | 34/94 vs 48/160, RR 1.21 (95% CI 0.84–1.72) | 17/94 vs 28/160, RR 1.03 (95% CI 0.60–1.78) |
| Seto E et al. | 3/50 vs 0/50, RR 7.00 (95% 0.37–132.10) | MLHFQ Control Group: p = 0.9; Intervention Group: p = 0.02; Between group post study: p = 0.2; Between group change scores data: p = 0.05 | 14/50 vs 10/50, RR 1.40 (95% CI 0.69–2.85) | N/A |
| Soran OZ et al. | RR 0.63 (95% CI 0.30–1.29) | N/A | RR 1.10 (95% CI 0.86–1.41) | Unadjusted HR 0.78 (95% CI 0.48–1.27); Adjusted HR (NYHA, B-blocker use, Sex, Na levels) 0.71 (95% CI 0.43–1.17) |
| Wakefield BJ et al. | HR 1.04 (95% CI 0.49–2.24; p = 0.91) at 12-month follow up | MLHFQ p = 0.0002 (changes over 6 months within all groups). Between-group p value not significant | OR 0.49 (95% CI 0.24–0.98; p = 0.04) at 12-month follow up | OR 0.58 (95% CI 0.21–1.56; p = 0.28) at 12-month follow up |
| Woodend AK et al. | RR 1.19 (95% CI 0.34–4.22) | RR 1.06 (95% CI 0.97–1.16) | ||
[i] Abbreviations: HR-QoL, health-related quality of life; MLHFQ, Minnesota Living with Heart Failure Questionnaire; SF, Short Form; TSM, telehealth self-monitoring; COM, comprehensive outpatient management; MD, mean difference; RR, relative risk; HR, hazard ratio; CI, confidence interval; OR, odd ratio; N/A, not available.
Figure 2
Central Illustration highlighting summary of this systematic review findings. HF: Heart Failure, HR-QoL: Health-Related Quality of Life; MLHFQ: Minnesota Living with Heart Failure Questionnaire.