Evaluating the Evidence Base for the Use of Home Telehealth Remote Monitoring in Elderly with Heart Failure

Abstract

Information and communication technology offers promise for better coordination of care for patients with congestive heart failure (CHF). MEDLINE, EMBASE, and CINHAL databases were searched for evidence on remote monitoring of patients with heart failure (HF). The search was restricted to randomized controlled trials using either automated monitoring of signs and symptoms or automated physiologic monitoring. For this review, telephone-based monitoring of signs and symptoms was not considered remote monitoring. Studies were also excluded if they did not present outcomes related to healthcare utilization. Nine studies met selection criteria, with interventions that varied greatly. Four three-arm studies directly compared the effectiveness of two different interventions to usual care. Six of the nine studies suggested a 27%-40% reduction in overall admissions. Two two-arm studies demonstrated a 40%-46% reduction in HF-related admissions while two other three-arm studies showed similar trends; however, this was not statistically significant. Three of nine studies suggested a significant reduction in mortality (30%-67%) and three studies showed significant reduction in healthcare utilization costs. Two studies suggested a 53%-62% reduction in bed days of care. Two studies showed significant reduction in the number of Emergency Department visits. Three two-arm studies and one three-arm study demonstrated significant overall improvement in outcomes with use of telemonitoring. Available data suggest that telemonitoring is a promising strategy. More data are needed to determine the ideal patient population, technology, and parameters, frequency and duration of telemonitoring, and the exact combination of case management and close monitoring that would assure consistent and improved outcomes with cost reductions in HF.

Remote Care Technology: A Systematic Review of Reviews and Meta-Analyses

“…Nine of the 51 retrieved articles reported on studies related to congestive heart failure [8][9][10]14,17,25,35,36,38]. The typical clinical parameters being measured (usually in a daily basis) were blood pressure, weight, heart rate, and oxygen saturation.…”

“…Interactive web applications allowing the automatic transmission of monitoring information, as well as the patients entering clinical information measurements, and additional information to be reviewed by clinicians at a later time [9,14,25,36,38].…”

Robot carers, ethics, and older people

“…Medical equipment that detects signs of deteriorating asthma, chronic heart and lung ailments or diabetes is now available (Garcia-Lizana and Sarria-Santamera 2007; Paré et al 2007). Some of this equipment sends information automatically to central response centres or medical practices (Dang et al 2009). Telehealth equipment can also send information about amounts of medication taken at different times.…”

An ethical analysis of telemedicine: implications for future research

“…Proponents of remote monitoring tout its potential to reduce healthcare costs by decreasing hospital admissions and mitigating adverse events (Dang et al, 2009). Remote monitoring is also posited to provide a means to decrease cost by managing chronic diseases (Macdonnell and Darzi, 2013).…”