J Clin Outcomes Manage
Heart failure disease management incorporating telemedicine: a critical review
Jerant AF, Nesbitt TS
Abstract Objectives: To summarize and critically review research regarding heart failure disease management (HFDM) programs incorporating telemedicine and to outline critical research gaps and approaches for addressing them. Methods: We searched MEDLINE and other databases for randomized controlled trials (RCTs) and systematic reviews published between 1966 and November 2004 comparing HFDM programs incorporating telemedicine with usual care. Broad definitions of disease management and telemedicine were employed to guide decisions regarding article inclusion. Results: We retrieved 5 prior systematic reviews on this topic, each employing different definitions of disease management and telemedicine, and 33 RCTs. Thirty of the RCTs were included in at least 1 of these reviews, and we found 3 additional RCTs not included in any of them. Considered together, the findings of the 33 RCTs suggest that, when targeted to recently hospitalized patients with moderate to severe heart failure, a variety of HFDM interventions incorporating telemedicine significantly reduced hospitalizations and emergency visits. Fewer studies examined the impact of HFDM programs on mortality, care costs, and quality of life, and their findings varied. Several RCTs targeted patients with less severe disease and/or enrolled in health systems with preexisting proactive approaches to chronic disease care and found no significant improvement in any outcomes. Conclusions: HFDM programs incorporating telemedicine can reduce acute care utilization by severely affected patients, but their impact on other outcomes is unproven. Less symptomatic patients and those cared for in well-organized health systems do not appear to benefit from HFDM. Many questions regarding HFDM remain, such as which program elements are most effective. We propose a HFDM taxonomy to help organize future research on this topic.
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