Long-term impact of home-based monitoring after an admission for acute decompensated heart failure: a systematic review and meta-analysis of randomised controlled trialsResearch in context
Summary: Background: Patients with heart failure have high rehospitalisation rates and poor cardiovascular outcomes. Home-based monitoring (HBM) has emerged with promising results in different settings. However, its long-term effects on patients recently admitted for acute decompensated heart failu...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2024-05-01
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| Series: | EClinicalMedicine |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2589537024001202 |
| _version_ | 1827312344206671872 |
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| author | Mariana R.C. Clemente Nicole Felix Denilsa D.P. Navalha Eric Pasqualotto Rafael Oliva Morgado Ferreira Marcelo A.P. Braga Alleh Nogueira Thomaz Alexandre Costa Alice D. Marinho Amanda Fernandes |
| author_facet | Mariana R.C. Clemente Nicole Felix Denilsa D.P. Navalha Eric Pasqualotto Rafael Oliva Morgado Ferreira Marcelo A.P. Braga Alleh Nogueira Thomaz Alexandre Costa Alice D. Marinho Amanda Fernandes |
| author_sort | Mariana R.C. Clemente |
| collection | DOAJ |
| description | Summary: Background: Patients with heart failure have high rehospitalisation rates and poor cardiovascular outcomes. Home-based monitoring (HBM) has emerged with promising results in different settings. However, its long-term effects on patients recently admitted for acute decompensated heart failure (ADHF) remain uncertain. Methods: We systematically searched PubMed, Embase, and Cochrane Library for randomised controlled trials (RCTs) comparing HBM with usual care (UC) that were published between database inception and June 24, 2023. We included studies with patients admitted for ADHF in the previous 6 months and with a minimum follow-up of 6 months. We excluded studies with patients hospitalised for reasons other than ADHF and studies with disproportional education interventions between arms. Statistical analyses were performed using R software version 4.3.2. We pooled risk ratios (RR) and mean differences (MD) with 95% confidence intervals (CI) for categorical and continuous outcomes, respectively. Cochrane Collaboration’s tool for assessing risk of bias in RCTs (RoB 2) was used to assess study quality. Publication bias was assessed via funnel plots and Egger’s test, and heterogeneity was assessed through I2 statistics and sensitivity analysis. The protocol for this systematic review and meta-analysis was registered in the International Prospective Register of Systematic Reviews (PROSPERO, CRD42023465359). Findings: We included 16 RCTs comprising 4629 patients, of whom 2393 (51.7%) were randomised to HBM and 3150 (68%) were men. Follow-up ranged from six to fifteen months. As compared with UC, HBM significantly reduced all-cause mortality (RR 0.75; 95% CI 0.61, 0.91; p = 0.005), all-cause hospitalisations (RR 0.82; 95% CI 0.70, 0.97; p = 0.018), cardiovascular (CV) mortality (RR 0.53; 95% CI 0.36, 0.79; p = 0.002), hospitalisations for heart failure (RR 0.75; 95% CI 0.62, 0.91; p = 0.004), and CV hospitalisations (RR 0.72; 95% CI 0.55, 0.95; p = 0.018). There were no significant differences in length of hospital stay (MD 0.97 days; 95% CI -0.90, 2.84; p = 0.308). Interpretation: In patients recently admitted with ADHF, HBM significantly reduces long-term all-cause mortality and hospitalisations, CV mortality and hospitalisations, and hospitalisations for heart failure, as compared with UC. This supports the implementation of HBM as a standard practice to optimise patient outcomes following admissions for ADHF. However, future studies are warranted to evaluate the efficacy and safety of implementing HBM in the real-world setting. Funding: None. |
| first_indexed | 2024-04-24T21:41:52Z |
| format | Article |
| id | doaj.art-b5e1e83863374488a9545501e297bc81 |
| institution | Directory Open Access Journal |
| issn | 2589-5370 |
| language | English |
| last_indexed | 2024-04-24T21:41:52Z |
| publishDate | 2024-05-01 |
| publisher | Elsevier |
| record_format | Article |
| series | EClinicalMedicine |
| spelling | doaj.art-b5e1e83863374488a9545501e297bc812024-03-21T05:37:19ZengElsevierEClinicalMedicine2589-53702024-05-0171102541Long-term impact of home-based monitoring after an admission for acute decompensated heart failure: a systematic review and meta-analysis of randomised controlled trialsResearch in contextMariana R.C. Clemente0Nicole Felix1Denilsa D.P. Navalha2Eric Pasqualotto3Rafael Oliva Morgado Ferreira4Marcelo A.P. Braga5Alleh Nogueira6Thomaz Alexandre Costa7Alice D. Marinho8Amanda Fernandes9Petrópolis School of Medicine, Petrópolis, Brazil; Corresponding author. Petrópolis School of Medicine, Av. Barão do Rio Branco, 1003 – Centro, Petrópolis, Rio de Janeiro, Brazil.Federal University of Campina Grande, Campina Grande, BrazilEduardo Mondlane University, Maputo, MozambiqueFederal University of Santa Catarina, Florianópolis, BrazilFederal University of Santa Catarina, Florianópolis, BrazilFederal University of Rio de Janeiro, Rio de Janeiro, BrazilBahiana School of Medicine and Public Health, Salvador, BrazilFederal University of Ceará, Fortaleza, BrazilFederal University of the State of Rio de Janeiro, Rio de Janeiro, BrazilDivision of Cardiology, Boston Medical Center, Boston, MA, USASummary: Background: Patients with heart failure have high rehospitalisation rates and poor cardiovascular outcomes. Home-based monitoring (HBM) has emerged with promising results in different settings. However, its long-term effects on patients recently admitted for acute decompensated heart failure (ADHF) remain uncertain. Methods: We systematically searched PubMed, Embase, and Cochrane Library for randomised controlled trials (RCTs) comparing HBM with usual care (UC) that were published between database inception and June 24, 2023. We included studies with patients admitted for ADHF in the previous 6 months and with a minimum follow-up of 6 months. We excluded studies with patients hospitalised for reasons other than ADHF and studies with disproportional education interventions between arms. Statistical analyses were performed using R software version 4.3.2. We pooled risk ratios (RR) and mean differences (MD) with 95% confidence intervals (CI) for categorical and continuous outcomes, respectively. Cochrane Collaboration’s tool for assessing risk of bias in RCTs (RoB 2) was used to assess study quality. Publication bias was assessed via funnel plots and Egger’s test, and heterogeneity was assessed through I2 statistics and sensitivity analysis. The protocol for this systematic review and meta-analysis was registered in the International Prospective Register of Systematic Reviews (PROSPERO, CRD42023465359). Findings: We included 16 RCTs comprising 4629 patients, of whom 2393 (51.7%) were randomised to HBM and 3150 (68%) were men. Follow-up ranged from six to fifteen months. As compared with UC, HBM significantly reduced all-cause mortality (RR 0.75; 95% CI 0.61, 0.91; p = 0.005), all-cause hospitalisations (RR 0.82; 95% CI 0.70, 0.97; p = 0.018), cardiovascular (CV) mortality (RR 0.53; 95% CI 0.36, 0.79; p = 0.002), hospitalisations for heart failure (RR 0.75; 95% CI 0.62, 0.91; p = 0.004), and CV hospitalisations (RR 0.72; 95% CI 0.55, 0.95; p = 0.018). There were no significant differences in length of hospital stay (MD 0.97 days; 95% CI -0.90, 2.84; p = 0.308). Interpretation: In patients recently admitted with ADHF, HBM significantly reduces long-term all-cause mortality and hospitalisations, CV mortality and hospitalisations, and hospitalisations for heart failure, as compared with UC. This supports the implementation of HBM as a standard practice to optimise patient outcomes following admissions for ADHF. However, future studies are warranted to evaluate the efficacy and safety of implementing HBM in the real-world setting. Funding: None.http://www.sciencedirect.com/science/article/pii/S2589537024001202Home-based monitoringRemote monitoringHeart failureAcute decompensated heart failure |
| spellingShingle | Mariana R.C. Clemente Nicole Felix Denilsa D.P. Navalha Eric Pasqualotto Rafael Oliva Morgado Ferreira Marcelo A.P. Braga Alleh Nogueira Thomaz Alexandre Costa Alice D. Marinho Amanda Fernandes Long-term impact of home-based monitoring after an admission for acute decompensated heart failure: a systematic review and meta-analysis of randomised controlled trialsResearch in context EClinicalMedicine Home-based monitoring Remote monitoring Heart failure Acute decompensated heart failure |
| title | Long-term impact of home-based monitoring after an admission for acute decompensated heart failure: a systematic review and meta-analysis of randomised controlled trialsResearch in context |
| title_full | Long-term impact of home-based monitoring after an admission for acute decompensated heart failure: a systematic review and meta-analysis of randomised controlled trialsResearch in context |
| title_fullStr | Long-term impact of home-based monitoring after an admission for acute decompensated heart failure: a systematic review and meta-analysis of randomised controlled trialsResearch in context |
| title_full_unstemmed | Long-term impact of home-based monitoring after an admission for acute decompensated heart failure: a systematic review and meta-analysis of randomised controlled trialsResearch in context |
| title_short | Long-term impact of home-based monitoring after an admission for acute decompensated heart failure: a systematic review and meta-analysis of randomised controlled trialsResearch in context |
| title_sort | long term impact of home based monitoring after an admission for acute decompensated heart failure a systematic review and meta analysis of randomised controlled trialsresearch in context |
| topic | Home-based monitoring Remote monitoring Heart failure Acute decompensated heart failure |
| url | http://www.sciencedirect.com/science/article/pii/S2589537024001202 |
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