Effects of home telemonitoring using non-invasive versus conventional approaches on patients affected by congestive heart failure: a systematic literature review and meta-analysis
Authors: Oronti Iyabosola B. , Lopez-Perez Laura , Piaggio Davide , Fico Giuseppe , Pecchia Leandro 
Published: July 2023

Abstract
Purpose
This study evaluates the effects of non-invasive home telemonitoring methods of managing congestive heart failure (CHF) patients with particular focus on complexity of intervention, patient characteristics, patient severity, and key enabling technologies (KETs) adopted. Our goal was to capture all possible aspects of previously documented outcomes and provide updated and clearer evidence on mixed effects on common themes.

Methods
Randomized controlled trials (RCTs) published between 1 January 2012 and 6 June 2019, focusing on home telemonitoring of patients with only CHF or CHF coexisting with other chronic disease(s), were retrieved from online resources (PubMed, Embase, MEDLINE(R), Your journals@Ovid, Elsevier, and ClinicalTrials.gov). The snowball sampling method and forward citation tracking on Google Scholar were also adopted to identify additional relevant studies. Retrieved studies were in a language known by the authors (i.e., English, Spanish or Italian). Quality assessment of individual studies for shortcomings in design, management, evaluation, and reporting was done using the Cochrane risk of bias (RoB) tool. Variables of interest were synthesized as differences in relative risk (RR), or as weighted mean differences (WMD). Outcomes were assigned as primary or secondary based on a principal judgement of clinical importance, and secondarily on highest recurrent counts in included studies.

Results
In all, 28 RCTs involving 10,258 patients were included in the qualitative synthesis, out of which 24 were used for the quantitative synthesis. These studies focused on non-invasive telemonitoring practices for home monitoring of CHF patients, through the deployment of different kinds of electronic/mobile devices, with most having wireless communication capabilities. Moreover, studies focusing on implantable monitoring devices in terms of inputs, data and patient performance were also included. Brain natriuretic peptide (BNP) ((WMD = -27.75; 95% CI (-53.36, -2.14); p-value = 0.034), rehospitalization/hospitalization for heart failure (RR = 0.88; 95% CI (0.79, 0.98); p-value = 0.015), cardiovascular death/heart failure hospitalization (RR = 0.70; 95% CI (0.51, 0.97); p-value = 0.03), and six minute walk test (6MWT) (WMD = 25.61; 95% CI (9.22, 41.99); p-value = 0.002) significantly improved in the telemonitoring group, while the number of visits to a nurse (WMD = 1.42; 95% CI (0.33, 2.52); p-value = 0.011) increased considerably compared to usual care.

Conclusion
Although there were limitations to the evidence provided in this review such as wide variations in certain variables (e.g., sample populations, RoB assessment, telemonitoring tools, follow-up periods), issues with allocation concealment and blinding of participants and personnel, and paucity of data for synthesizing particular outcomes of interest, overall, telemonitoring seems to offer much better results in the treatment of CHF patients compared to usual care.

Registration and protocol
This systematic review and meta-analysis has been retrospectively registered in the Open Science Framework (OSF) repository with https://doi.org/10.17605/OSF.IO/NDXCP. All data related to this study, including the electronic supplementary data, can be found at this link: osf.io/57q3h.