title: Effect of telemonitoring of cardiac implantable electronic devices on healthcare utilization: a meta-analysis of randomized controlled trials in patients with heart failure.
abstract: OBJECTIVE
  Implantable 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.
  
  
  RESULTS
  This 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).
  
  
  CONCLUSIONS
  Compared 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.
authors.affiliation: Service of Biometry & Statistics, IRCCS Fondazione Policlinico S Matteo, Pavia, Italy.
authors.forename: Catherine
authors.initials: C
authors.lastname: Klersy
authors.affiliation: Cardiology Department, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Boriani
authors.affiliation: Service of Biometry & Statistics, IRCCS Fondazione Policlinico S Matteo, Pavia, Italy.
authors.forename: Annalisa
authors.initials: A
authors.lastname: De Silvestri
authors.affiliation: Cliniques du Sud Luxembourg, Arlon, Belgium.
authors.forename: Georges H
authors.initials: GH
authors.lastname: Mairesse
authors.affiliation: Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Frieder
authors.initials: F
authors.lastname: Braunschweig
authors.affiliation: Centre for Scientific Documentation, IRCCS Fondazione Policlinico S Matteo, Pavia, Italy.
authors.forename: Valeria
authors.initials: V
authors.lastname: Scotti
authors.affiliation: Centre for Scientific Documentation, IRCCS Fondazione Policlinico S Matteo, Pavia, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Balduini
authors.affiliation: Centre for Scientific Documentation, IRCCS Fondazione Policlinico S Matteo, Pavia, Italy.
authors.forename: Martin R
authors.initials: MR
authors.lastname: Cowie
authors.affiliation: Aston Medical Research Institute, Aston Medical School, Aston University, Birmingham, UK.
authors.forename: Francisco
authors.initials: F
authors.lastname: Leyva
mesh_terms: D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D017048:Health Care Costs; D006333:Heart Failure / Q000175:diagnosis* / Q000191:economics* / Q000628:therapy; D006760:Hospitalization / Q000191:economics; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D017216:Telemedicine
keywords: Cardiac implantable electronic devices; Heart failure; Remote monitoring; Telemonitoring