Digital health intervention in patients with recent hospitalization for acute heart failure: A systematic review and meta-analysis of randomized trials. (15th July 2022) - Elbadawi, Ayman
Abstract: Aim: To examine the efficacy of digital health interventions (DHI) versus standard of care among patients with prior heart failure (HF) hospitalization. Methods: An electronic search of MEDLINE, Cochrane, OVID, CINHAL and ERIC, databases was performed through August 2021 for randomized clinical trials that evaluated the outcomes with DHI among patients with HF. Data were pooled using the random-effects model. The primary outcome was all-cause mortality. Results: 10 randomized trials were included in our analysis, with a total of 7204 patients and a weighted follow up duration of 15.6 months. Compared with the reference group, patients in the DHI group had lower all-cause mortality (8.5% vs. 10.2%, risk ratio-RR 0.80; 95% confidence interval-CI 0.66 to 0.96; P = 0.02), as well as lower cardiovascular mortality (7.3% vs. 9.6%, RR 0.76; 95% CI 0.62 to 0.94; P = 0.01). There was no significant difference in HF-related hospitalizations (23.4% vs. 26.2%, RR 0.82; 95% CI 0.66 to 1.02; P = 0.07) and all-cause hospitalizations (48.3% vs. 49.9%, RR 0.89; 95% CI 0.77 to 1.03; P = 0.11) in the DHI versus reference groups. Patients in the DHI group had fewer days lost due to HF-related hospitalizations (mean difference-MD: -1.77; 95% CI -3.06, -0.48, p = 0.01; I 2 = 51), but similar days lost to all-cause hospitalizations (MD: -0.76; 95% CI -3.07, -1.55, p = 0.52; I 2 = 69) compared with patients in the reference group. Conclusion: Compared with usual care, DHI among patients with HF provided significant reduction of all-cause mortality and cardiovascular mortality and had fewer total days lost to HF hospitalizations. There were no differences in all-cause hospitalizations, and HF hospitalizations. Highlights: DHI in patients with prior HF hospitalizations showed a reduction in all-cause mortality and cardiovascular mortality. There were fewer total days lost to HF hospitalizations among the DHI versus the usual care groups. There were no differences in all-cause hospitalizations, HF hospitalizations between DHI and the usual care groups. Further investigations are warranted to evaluate the role of various methods and cost-effectiveness of DHI in HF management.