A meta-analysis of randomized clinical trials and cohort studies regarding treatment of heart failure patients reveals benefits from technology. (JACC Abstract) Heart failure is one of the most expensive conditions to treat, primarily because the patients tend to have multiple hospitalizations. A number of disease management approaches have been adopted in recent years to try to minimize these hospitalizations and other costs related to these patients. The meta-analysis examined a significant number of studies which compared usual care for heart failure with either an intensive telephone follow-up program or remote electronic monitoring of physiologic indicators or both.
The primary outcomes were avoidance of hospitalizations and number of deaths. There were 32 studies and over 8500 patients in the meta-analysis. Most of the studies were randomized clinical trials, usually considered the gold standard in research, but a number were cohort studies which can help understand real world effects. The meta-analysis revealed that there were significantly fewer deaths and hospitalizations, both for heart failure and other conditions, in the telephone follow-up and remote monitoring programs than in usual care. Remote monitoring was slightly better than telephone follow-up.
The study notes that while these new approaches are spreading, there are many questions about what parameters to monitor, how best to monitor them and how to ensure appropriate follow-up by health care professionals. The article also emphasizes that the cost-effectiveness of these new approaches needs to be evaluated. But in at least the area of heart failure treatment, it appears that innovations in care utilizing communications and other technologies can make a meaningful difference in health outcomes.