The clinical effectiveness of telemedicine for chronic heart failure: A systematic review and meta-analysis.

INTRODUCTION: Telemedicine interventions had been found to effectively reduce all-cause mortality and hospital admission rate of the patients with heart failure (HF). This study aims to update the clinical benefit of telemedicine for HF. EVIDENCE ACQUISITION: Literature databases (updated to June 30, 2016) were searched for randomized controlled trials for HF patients, in which the participants were randomized into telemedicine group (tele-transmission, telephone-supported care, and implantable monitoring) or the usual standard care group. EVIDENCE SYNTHESIS: A total of 42 studies were included. For the telemedicine groups in general, all-cause mortality (P = 0.001), HF-related admission rate (P <0.001), HF-related length of stay (P = 0.041) were significantly lower compared with the control group. For the tele-transmission group, all-cause mortality (P=0.001), HF-related admission rate (P=0.008), HF-related length of stay (P = 0.039) and HF-related mortality (P=0.001) were significantly lower compared with the control group. For the telephone-supported care group, only HF- related admission rate (P<0.001) was significantly lower compared with the control group. Implantable monitoring group showed no significant difference in all-cause mortality compared with the control group. CONCLUSION: Overall, telemedicine was shown to be beneficial in patients with heart failure. Home-based tele-transmission interventions effectively reduce all-cause mortality and HF- related hospital admission, length of stay and mortality. Telephone-supported care only show benefit in reduction of HF-related hospital admission rate.