Abstract
Heart failure represents a significant burden for patients and the Canadian health
care system. Home telemonitoring is proposed as an intervention that can improve heart
failure outcomes by identifying opportunities for earlier clinical intervention and
by providing patients with self-management support between scheduled clinic visits.
The objective of this review is to provide clarity with respect to the most recent
evidence of the effect of home telemonitoring on heart failure outcomes. Despite some
strong evidence that telemonitoring can reduce the risk of mortality and heart failure-related
hospitalizations, important inconsistencies exist in the evidence. This article proposes
that much of the inconsistency results from differences in the patient population
being studied, the type of home telemonitoring intervention, and the implementation
setting. Also important is the degree to which intervention fidelity is maintained
throughout the course of a study; this is emphasized through a review of the factors
that influence the degree to which patients and health care providers use home telemonitoring
interventions as intended. In this article we propose that for researchers to produce
definitive answers regarding the effect of home telemonitoring on heart failure outcomes,
interventions and studies need to be designed and tailored according to the characteristics
of the target patient population and the implementation context.
Résumé
L’insuffisance cardiaque représente un fardeau important pour les patients et le système
de soins de santé canadien. La télésurveillance à domicile est proposée en tant qu’intervention
susceptible d’améliorer les résultats dans les cas d’insuffisance cardiaque, du fait
qu’elle permet de cerner les possibilités d’intervention clinique précoce et procure
aux patients une assistance en matière d’autoprise en charge entre les rendez-vous
en clinique. Le présent article de synthèse vise à faire la lumière sur les preuves
les plus récentes de l’effet de la télésurveillance à domicile sur les résultats dans
les cas d’insuffisance cardiaque. Des données convaincantes montrent que la télésurveillance
peut réduire le risque de mortalité et d’hospitalisations liées à l’insuffisance cardiaque.
Néanmoins, ces données présentent d’importantes incohérences. Ces incohérences sont,
selon nous, attribuables en grande partie aux différences touchant la population de
patients étudiée, le type de télésurveillance à domicile et le cadre de mise en œuvre.
Le degré d’observance des modalités de l’intervention tout au long d’une étude a aussi
de l’importance; ce fait ressort de l’examen des facteurs qui influent sur le degré
de concordance entre la mise en œuvre effective de la télésurveillance à domicile
par les patients et les professionnels de la santé, et la mise en œuvre prévue. Pour
que les chercheurs puissent caractériser de façon définitive l’effet de la télésurveillance
à domicile sur les résultats dans les cas d’insuffisance cardiaque, nous estimons
que les interventions et les études doivent être conçues en fonction des caractéristiques
de la population de patients cible et du contexte de mise en œuvre, et y être adaptées.
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Article info
Publication history
Published online: February 03, 2018
Accepted:
January 21,
2018
Received:
October 23,
2017
Footnotes
See page 902 for disclosure information.
Identification
Copyright
© 2018 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
