Background: Telemonitoring studies in chronic heart failure are characterized by mixed mortality and hospitalization outcomes, which have deterred the uptake of telemonitoring in clinical practice. These mixed outcomes may reflect the diverse range of patient management strategies incorporated in telemonitoring. To address this, we compared the effects of different telemonitoring strategies on clinical outcomes. Objective: The aim of this systematic review and subgroup meta-analysis was to identify noninvasive telemonitoring strategies attributing to improvements in all-cause mortality or hospitalization outcomes for patients with chronic heart failure. Methods: We reviewed and analyzed telemonitoring strategies from randomized controlled trials (RCTs) comparing telemonitoring intervention with usual care. For each strategy, we examined whether RCTs that applied the strategy in the telemonitoring intervention (subgroup 1) resulted in a significantly lower risk ratio (RR) of all-cause mortality or incidence rate ratio (IRR) of all-cause hospitalization compared with RCTs that did not apply this strategy (subgroup 2). Results: We included 26 RCTs (N=11,450) incorporating 18 different telemonitoring strategies. RCTs that provided medication support were found to be associated with a significantly lower IRR value than RCTs that did not provide this type of support (P=.01; subgroup 1 IRR=0.83, 95% CI 0.72-0.95 vs subgroup 2 IRR=1.02, 95% CI 0.93-1.12). RCTs that applied mobile health were associated with a significantly lower IRR (P=.03; IRR=0.79, 95% CI 0.64-0.96 vs IRR=1.00, 95% CI 0.94-1.06) and RR (P=.01; RR=0.67, 95% CI 0.53-0.85 vs RR=0.95, 95% CI 0.84-1.07). Conclusions: Telemonitoring strategies involving medication support and mobile health were associated with improvements in all-cause mortality or hospitalization outcomes. These strategies should be prioritized in telemonitoring interventions for the management of patients with chronic heart failure.

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中文翻译：

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不同的远程监护策略对慢性心力衰竭护理的影响：系统评价和亚组荟萃分析

背景：慢性心力衰竭的远程监护研究的特点是死亡率和住院结局混合，这阻碍了远程监护在临床实践中的应用。这些混杂的结果可能反映了远程监护中纳入的患者管理策略的范围很广。为了解决这个问题，我们比较了不同的远程监护策略对临床结果的影响。目的：本系统综述和亚组荟萃分析的目的是确定可改善慢性心力衰竭患者全因死亡率或住院结局的无创远程监测策略。方法：我们回顾并分析了将远程监控干预与常规护理相比较的随机对照试验（RCT）的远程监控策略。对于每种策略，我们研究了在远程监控干预中应用该策略的RCT（第1组）是否导致全因住院的风险比（RR）或全因住院的发生率比（IRR）显着低于未应用的RCT此策略（第2组）。结果：我们纳入了26种RCT（N = 11,450），其中包含18种不同的远程监控策略。发现提供药物支持的RCT与未提供此类支持的RCT的IRR值显着相关（P = .01；第1组IRR = 0.83，95％CI 0.72-0.95 vs第2组IRR = 1.02 ，95％CI 0.93-1.12）。应用移动医疗的RCT与显着较低的IRR（P = .03; IRR = 0.79，95％CI 0.64-0.96 vs IRR = 1.00，95％CI 0.94-1.06）和RR（P = .01; RR = 0.67，95％CI 0.53-0.85，RR = 0.95，95％CI 0.84-1.07）。结论：涉及药物支持和移动健康的远程监控策略与全因死亡率或住院结局的改善有关。在管理慢性心力衰竭患者的远程监控干预措施中，应优先考虑这些策略。

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