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

Background
Previous reviews have investigated the effectiveness of telemedicine in the treatment of heart failure (HF). Dependent variables have included hospitalizations, mortality rates, disease knowledge and health costs. Few reviews, however, have examined the variable of health-related quality of life (QoL).

Methods
Randomized controlled trials comparing the delivery methods of any form of telemedicine with usual care for the provision of HF disease-management were identified via searches of all relevant databases and reference lists. To be included studies had to report a quantitative measure for mental, physical or overall QoL.

Results
33 studies were identified. However, poor reporting of data resulted in the exclusion of 7, leaving 26 studies with 7,066 participants. 3 separate, random effects meta-analyses were conducted for mental, physical and overall QoL. Telemedicine was not significantly more effective than usual care on mental and physical QoL (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, when compared to usual care, telemedicine was associated with a small significant increase in overall QoL (SMD 0.23, [95% CI 0.09-0.37], P = 0.001). Moderator analyses indicated that telemedicine delivered over a long-duration (≥52 weeks) and via telemonitoring was most beneficial.

Conclusion
Compared to usual care, telemedicine significantly increases overall QoL in patients receiving HF disease management. Statistically non-significant but nonetheless positive trends were observed for physical QoL, also. This provides preliminary support for the use of telemedicine in the management of heart failure without jeopardising patient well-being.