A systematic review of telemonitoring technologies in heart failure

Maric, Biljana; Kaan, Annemarie; Ignaszewski, Andrew; Lear, Scott A.

doi:10.1093/eurjhf/hfp036

Cited by 121 publications

(104 citation statements)

References 42 publications

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“…Examples include calls relating to web-based alcohol cessation interventions [54]; and virtual reality in stroke therapy, despite this being found [37] to be 'potentially exciting and safe'. More work on telemonitoring in heart failure is called for [55]; on e-therapy for mental health problems [56]; on smart home technologies [57]; and on technological support for carers of people with dementia [58]. Others [28] underlined that lack of evidence does not imply lack of effectiveness, and that in many cases interventions are simply 'unproven'.…”

Section: Evidence Is Limited and Inconsistentmentioning

confidence: 99%

Effectiveness of telemedicine: A systematic review of reviews

Ekeland¹,

Bowes²,

Flottorp³

2010

International Journal of Medical Informatics

917

649

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To conduct a review of reviews on the impacts and costs of telemedicine services. Methods: A review of systematic reviews of telemedicine interventions was conducted. Interventions included all e-health interventions, information and communication technologies for communication in health care, Internet-based interventions for diagnosis and treatments, and social care if important part of health care and in collaboration with health care for patients with chronic conditions were considered relevant. Each potentially relevant systematic review was assessed in full text by one member of an external expert team, using a revised check list from EPOC (Cochrane Effective Practice and Organisation of Care Group) to assess quality. Qualitative analysis of the included reviews was informed by principles of realist review. Results: In total 1593 titles/abstracts were identified. Following quality assessment, the review included 80 heterogeneous systematic reviews. Twenty one reviews concluded that telemedicine is effective, 18 found that evidence is promising but incomplete and others that evidence is limited and inconsistent. Emerging themes are the particularly problematic nature of economic analyses of telemedicine, the benefits of telemedicine for patients, and telemedicine as complex and ongoing collaborative achievements in unpredictable processes. Conclusions: The emergence of new topic areas in this dynamic field is notable and reviewers are starting to explore new questions beyond those of clinical and cost effectiveness. Reviewers point to a continuing need for larger studies of telemedicine as controlled interventions, and more focus on patients' perspectives, economic analyses and on telemedicine innovations as complex processes and ongoing collaborative achievements. Formative assessments are emerging as an area of interest.2 Introduction Previous reviews of telemedicine have concluded that irrefutable evidence regarding the positive impact of telemedicine on clinical outcomes still eludes us. One review [1] of more than 150 articles concluded that potential effectiveness could only be attributed to teleradiology, telepsychiatry, transmission of echocardiographic images and consultations between primary and secondary health providers. Another systematic review [2] that assessed more than 1300 papers making claims about telemedicine outcomes found only 46 publications that actually studied at least some clinical outcomes. A review that analyzed the suitability of telemedicine as an alternative to face-to-face care [3] concluded that establishing systems for patient care using telecommunications technologies is feasible; however, the studies provided inconclusive results regarding clinical benefits and outcomes. A report on peer-reviewed literature for telemedicine services that substituted face-to-face services with ICT based services at home and in offices or hospitals [4] identified 97 articles that met the inclusion criteria for analysis. The authors concluded that telemedicine is being used even if the use ...

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Section: Evidence Is Limited and Inconsistentmentioning

confidence: 99%

Effectiveness of telemedicine: A systematic review of reviews

Ekeland¹,

Bowes²,

Flottorp³

2010

International Journal of Medical Informatics

917

649

View full text Add to dashboard Cite

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“…[33] TM shows to have the potential to reduce the number of readmissions. [7,11,34] The respondents in the present study believed that TM leads to a better management of comorbidities and a decrease in readmissions in CHF, resulting in cost savings. The external validity of their opinions can however be questioned as all of the included projects stopped after the pilot phase.…”

Section: Facilitating Experiencesmentioning

confidence: 78%

“…[9] Many reviews have focused on the clinical outcomes and benefits of TM in the management of chronic diseases. [8,10,11] TM was related to a decrease in hospital readmissions and an increase in quality of life. [7,8,12] Inglis et al (2010) describes a 34% reduction in risk of all-cause mortality and a 9% reduction of all cause hospitalization compared to usual care.…”

Section: Introductionmentioning

confidence: 96%

Facilitating and inhibiting factors to implement telemonitoring: A qualitative study

Willemse

Remmen

Adriaenssens

et al. 2016

IJH

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Objective: Despite the added value of telemonitoring (TM) in the management of chronic care, widespread implementation and continuation is failing. The aim of this qualitative study was to explore the facilitators and inhibitors for successful implementation among field experts and health care providers in the projects of TM in primary care. Methods: An exploratory qualitative design using semi-structured interviews with field experts of TM projects in Belgium. Results: The eight interviewees reported an overall positive perception on the actual use of TM. They emphasized that TM provides a promising approach to the ageing population with an increasing burden of chronic diseases. TM was said to increase disease awareness in patients with chronic heart failure. The interviewees were willing to use the new technology. Sharing patient data between health care professionals optimizes care continuity and transmural collaboration, with the focus on problem detection. However, TM in their projects was perceived as an additional task as it was not embedded in regular care. Coordination of care using TM was felt to be incomplete. Agreements on tasks and responsibilities in sharing patient data were unclear. The management and centralisation of data was difficult and impeded implementation in regular care. Furthermore, the interviewees noted that sustainability of their efforts was hampered as the projects would not be financed in the future. Conclusions: Field experts of pilot TM projects believe in benefits of TM and the willingness of health care providers to use the technology. To successfully implement TM in regular care the reported barriers need to be considered. Transmural collaboration with interaction and involvement of the chronic patient and a proactive team of care professionals is required. Efforts should be made to integrate TM in regular care, both structurally and financially.

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“…Multidisciplinary or nurse lead rehabilitation carried out during the acute hospital stay and in out-patients clinics have been shown to increase patients' self-care ability and patients' management of everyday life with HF. [9][10][11][12][13][14][15][16][17][18] No studies have tested whether further improvement in the outcome of rehabilitation can be obtained if patients are supported during the transition from phase two to phase three in their rehabilitation. In general, there is little evidence for the effect of rehabilitation interventions after discharge from outpatient clinics.…”

Section: Introductionmentioning

confidence: 99%

“…Selfcare has been used as an outcome of rehabilitation but not as a means to improving well-being and Health Status. [9][10][11][12][13][14][15][16][17][18]23] Planning care in respect of the individual patient's experience of the situation to a greater extent results in changes in patient behaviours that are regarded as positive for Health Status and preventing disease progression. [24][25][26][27] It requires involvement of the patient in the planning of the care process and also that the patient is able to make decisions and to convert knowledge acquired from the provided education to beneficial actions in practice.…”

Section: Introductionmentioning

confidence: 99%

Effect of Clinical Nurses Specialists intervention on rehabilitation outcomes in patients with heart failure

Larsen

Thomsen

Pedersen

2014

Clinical Nursing Studies

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Introduction: Living with heart failure is serious and call for long term rehabilitation care. Rehabilitation elements for patients with Heart Failure are based on the recommendations from the European Society of Cardiology and focuses on self-care and adherence in general. The aim of this study was, therefore, to test a protocol for rehabilitation of patients after completing rehabilitation in the outpatient clinic. Method:The study design is quasi-experimental. Patients in the control group follow the conventional rehabilitation. For the patients in the intervention group an individual rehabilitation plan was prepared and followed up by telephone after 4 and 12 weeks. For all patients Health Status were measured with Short Form 36 and EQ5D.Results: One hundred and sixty-two patients are included in the study of which 137 (84.6%) consented. There were no differences in total self-care behavior between the groups at baseline and at follow-up after 4 and 12 weeks. Within the control group no changes in the self-care score from baseline to follow-up were observed. Total EQ5D scores showed no significant differences between the groups at baseline. Subgroup analyses showed a significant difference in usual activities and decrease in anxiety/depression in the intervention group with a within-group increase from 34.4 percent at baseline to 51.4 percent after 12 weeks (p = .0002). No between-groups differences at 4 weeks or 12 weeks were observed.Conclusion: No significant increase in Health Status between groups were found. Subgroup analysis showed a significant within-group decrease in development of anxiety in the intervention group from baseline to twelve weeks. There may be a correlation between the increase in self-care behavior in patients in the intervention group after 12 weeks and a reduction in anxiety.

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A systematic review of telemonitoring technologies in heart failure

Cited by 121 publications

References 42 publications

Effectiveness of telemedicine: A systematic review of reviews

Effectiveness of telemedicine: A systematic review of reviews

Facilitating and inhibiting factors to implement telemonitoring: A qualitative study

Effect of Clinical Nurses Specialists intervention on rehabilitation outcomes in patients with heart failure

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