Is telemonitoring effective in older adults affected by heart failure? A meta-analysis focused on this population

Background and aims. Telemonitoring might improve outcomes in older adults affected by heart failure. However, study results are contrasting, and no meta-analyses are available focused on this population. The objective of this meta-analysis was to assess the effectiveness of telemonitoring in reducing all-cause mortality, all-cause and heart failure-related hospitalizations and emergency department visits in older adults affected by heart failure. Methods. We performed a systematic search on Pubmed for randomized controlled trials published up to 31st October 2018 studying the effectiveness of telemonitoring in improving outcomes, compared to usual care, in older adults with HF or with a pre-specified sub-analysis on this population. Both fixed and random-effects models were used to calculate the pooled RR (95% CI). Results. 8 randomized controlled trials (1909 participants, mean age 76.8 years, 53% female) were included in the meta-analysis. Telemonitoring did not reduce mortality (RR 0.87, 95% CI 0.69-1.09), emergency department visits (RR 1.00, 95% CI 0.72-1.39), nor all-cause hospitalizations (RR 0.96, 95% CI 0.84-1.10), while was evident a reduction in heart failure-related hospitalizations (RR 0.76, 95% CI 0.56-1.03). Heterogeneity across studies was low (I-2 39% for emergency department visits, and about 0% for all the other outcomes). Conclusions. Telemonitoring might reduce the risk of heart failure-related hospitalizations in older adults affected by heart failure. Further studies are needed to assess the role of telemonitoring in this population, taking into account comorbidities, disability, frailty, in order to clearly identify which patients may most beneficiate of this technology.