Effect of telemonitoring of cardiac implantable electronic devices on healthcare utilization: a meta-analysis of randomized controlled trials in patients with heart failure
Effect of telemonitoring of cardiac implantable electronic devices on healthcare utilization: a meta-analysis of randomized controlled trials in patients with heart failure
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DOI：
10.1002/ejhf.470
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发表时间：
2016-02-01
影响因子：
18.2
通讯作者：
Leyva, Francisco
中科院分区：
文献类型：
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作者：
Klersy, Catherine;Boriani, Giuseppe;Leyva, Francisco
植入式设备远程监护（DTM）是传统面对面医院访问的诊断辅助手段。DTM促进的远程设备随访和早期诊断应降低医疗保健利用率。我们探讨了DTM是否在不影响患者结局的情况下降低了标准治疗（SoC）的医疗保健利用率。方法和结果这项对11项关于心力衰竭患者的DTM随机对照试验的系统性综述和荟萃分析包括5702名患者，每项研究的中位患者为117例[四分位距（IQR）76-331][年龄65岁（IQR 63-67）]，随访时间范围为12-36个月。DTM与总就诊次数[计划、非计划和急诊室（ER）]的减少相关[相对风险（RR）0.56; 95%置信区间（CI）0.43-0.73，P < 0.001]。DTM组和SoC组的心脏病住院率（RR 0.96; 95% CI 0.82-1.12，P = 0.60）和ER、计划外医院访视或住院的复合终点（RR 0.99; 95% CI 0.68-1.43，P = 0.96）相似。观察到ER或计划外访视总数增加（RR 1.37; 95% CI 1.11-1.70，P = 0.004）。所有研究的这一效应均一致且具有统计学显著性。两组的总死亡率和心源性死亡率相似（DTM RR 0.90; 95% CI 0.69-1.16，P = 0.41; DTM RR 0.93; 95% CI 0.51-1.69，P = 0.80）。货币成本有利于DTM（10-55%，减少在五项研究）。ConclusionsCompared with SoC，DTM与计划的医院就诊显着减少。此外，DTM与较低的货币成本有关，尽管计划外的医院和急诊室就诊略有增加。DTM不会影响生存。
AimsImplantable device telemonitoring (DTM) is a diagnostic adjunct to traditional face-to-face hospital visits. Remote device follow-up and earlier diagnoses facilitated by DTM should reduce healthcare utilization. We explored whether DTM reduces healthcare utilization over standard of care (SoC), without compromising patient outcomes.Methods and resultsThis systematic review and meta-analysis of 11 randomized controlled trials on DTM in patients with heart failure consisted of 5702 patients, with a median of 117 [interquartile range (IQR) 76-331] patients per study [age 65 years (IQR 63-67)] and follow-up range of 12-36 months. DTM was associated with a reduction in total number of visits [planned, unplanned, and emergency room (ER)] [relative risk (RR) 0.56; 95% confidence interval (CI) 0.43-0.73, P < 0.001]. Rates of cardiac hospitalizations (RR 0.96; 95% CI 0.82-1.12, P = 0.60) and the composite endpoints of ER, unplanned hospital visits, or hospitalizations (RR 0.99; 95% CI 0.68-1.43, P = 0.96) was similar between the DTM and the SoC groups. An increase in the total number of ER or unscheduled visits (RR 1.37; 95% CI 1.11-1.70, P = 0.004) was observed. This effect was consistent and statistically significant for all studies. Total and cardiac mortality were similar between the groups (DTM RR 0.90; 95% CI 0.69-1.16, P = 0.41; and DTM RR 0.93; 95% CI 0.51-1.69, P = 0.80). Monetary costs favoured DTM (10-55% reduction in five studies).ConclusionsCompared with SoC, DTM is associated with a marked reduction in planned hospital visits. In addition, DTM was associated with lower monetary costs, despite a modest increase in unplanned hospital and ER visits. DTM did not compromise survival.