Quality of life in patients receiving telemedicine enhanced chronic heart failure management: a meta-analysis

Abstract

Background: Previous reviews (Inglis, Clark, McAlister, Stewart, & Cleland, 2011; Kotb, Cameron, Hsieh, & Wells, 2015) have investigated how heart failure (HF) disease management delivered via telemedicine has impacted outcomes including; hospitalizations, mortality rates and disease knowledge. No reviews, however, have aggregated effect sizes for health-related quality of life (QoL). This forms an important outcome of consideration given that research has indicated a relationship between low QoL and poor HF outcomes (Freedland, et al., 2003). Methods: Relevant databases were searched using appropriate keywords with reference lists of relevant studies being hand-searched. One reviewer extracted all the data. Randomized controlled trials comparing the delivery methods of any form of telemedicine with usual care for the provision of HF disease-management were identified; where studies had to report QoL for inclusion. Moderator analyses were conducted on telemedicine modality and length. Results 29 studies met inclusion criteria involving 7,066 participants. When comparing mental and physical QoL, to usual care, telemedicine showed no significant effect (SMD 0.03, (95% CI -0.05-0.12), P = 0.45 and SMD 0.24, (95% CI -0.08-0.56), P = 0.14, respectively). However, comparison of overall QoL with usual care, resulted in telemedicine demonstrating a small significant effect (SMD 0.23, [95% CI 0.09-0.37], P = 0.001). Discussion: Compared to usual care, telemedicine significantly increases overall QoL in patients receiving HF disease management. Moderator analyses found that telemedicine delivered longitudinally (≥52 weeks) via remote-monitoring was most beneficial. This provides preliminary support for the use of telemedicine in management of heart failure without jeopardising patient well-being.