Telemonitoring for Heart Failure

Telemonitoring for heart failure patients at home is one of the longer-standing uses of telemedicine.  It also has a somewhat significant body of research.  An article in Health Affairs summarizes and performs a meta-analysis on that body of research.   (HA Article)   Currently it is estimated that around 6 million Americans have heart failure, costing the health system $100 billion annually, with few effective treatments.  Hospitals and physicians have been under pressure to keep these patients out of the hospital, so telemonitoring has been widespread for years, although Medicare payment policies have hindered its adoption in that program (while at the same time CMS is punishing hospitals for heart failure readmissions).  This meta-analysis looked at randomized controlled trials from 2001 to 2016.  The trials had to include vital sign monitoring and transmission.  Outcomes looked at included all-cause and heart failure-related mortality and hospital use.  Only 26 studies met all the criteria for inclusion in the meta-analysis.  Across these trials, there were about 2500 patients in the intervention group and 2400 in the control group.  At 180 days after start of the intervention, home telemonitoring was associated with a 40% decrease in the chance of all-cause mortality, but the decrease was not statistically significant at one-year followup.  Two studies, so a small number, found that heart failure-related mortality was lower at 180 days with telemonitoring.  The intervention was not associated with a decline in either all-cause or heart-failure specific hospitalizations.  And home telemonitoring was associated with a greater use of the emergency room.  This may not be all bad if it means that providers are getting an earlier warning of a potential disease exacerbation and intervening quickly.  Overall, the meta-analysis suggests that home monitoring has an early effect on mortality that does not seem to persist, but that may be a natural consequence of the disease, which simply can’t be reversed with current treatment options.  Telemonitoring may also not be cost-effective, but it may still be the right thing to do if it leads to better overall care of the patient.