title: Effective technologies for noninvasive remote monitoring in heart failure.
abstract: BACKGROUND
  Trials of new technologies to remotely monitor for signs and symptoms of worsening heart failure are continually emerging. The extent to which technological differences impact the effectiveness of noninvasive remote monitoring for heart failure management is unknown. This study examined the effect of specific technology used for noninvasive remote monitoring of people with heart failure on all-cause mortality and heart failure-related hospitalizations.
  
  
  METHODS
  A subanalysis of a large systematic review and meta-analysis was conducted. Studies were stratified according to the specific type of technology used, and separate meta-analyses were performed. Four different types of noninvasive remote monitoring technologies were identified, including structured telephone calls, videophone, interactive voice response devices, and telemonitoring.
  
  
  RESULTS
  Only structured telephone calls and telemonitoring were effective in reducing the risk of all-cause mortality (relative risk [RR]=0.87; 95% confidence interval [CI], 0.75-1.01; p=0.06; and RR=0.62; 95% CI, 0.50-0.77; p<0.0001, respectively) and heart failure-related hospitalizations (RR=0.77; 95% CI, 0.68-0.87; p<0.001; and RR=0.75; 95% CI, 0.63-0.91; p=0.003, respectively). More research data are required for videophone and interactive voice response technologies.
  
  
  CONCLUSIONS
  This subanalysis identified that only two of the four specific technologies used for noninvasive remote monitoring in heart failure improved outcomes. When results of studies that involved these disparate technologies were combined in previous meta-analyses, significant improvements in outcomes were identified. As such, this study has highlighted implications for future meta-analyses of randomized controlled trials focused on evaluating the effectiveness of remote monitoring in heart failure.
authors.affiliation: 1 School of Nursing, Queensland University Technology , Kelvin Grove, Queensland, Australia .
authors.forename: Aaron
authors.initials: A
authors.lastname: Conway
authors.forename: Sally C
authors.initials: SC
authors.lastname: Inglis
authors.forename: Robyn A
authors.initials: RA
authors.lastname: Clark
mesh_terms: D040421:Cell Phone / Q000706:statistics & numerical data; D018450:Disease Progression; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008991:Monitoring, Physiologic / Q000295:instrumentation / Q000379:methods; D016032:Randomized Controlled Trials as Topic; D058998:Remote Sensing Technology / Q000295:instrumentation* / Q000379:methods; D015203:Reproducibility of Results; D017216:Telemedicine / Q000295:instrumentation / Q000379:methods; D013686:Telemetry / Q000295:instrumentation* / Q000379:methods; D014741:Video Recording / Q000706:statistics & numerical data
keywords: heart failure; meta-analysis; remote monitoring; systematic review
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