Effectiveness of telemedicine in patients with chronic heart failure: A systematic review and meta-analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIU Yan ^1,2 , YIN Jiajia ² ,  YAO Li ³ , WANG Yinhua ¹ , WANG Tingrui ² , LI Qinqin ² , WANG Wen ⁴

1. Department of Nursing, Affiliated Hospital of Guizhou Medical University, Guiyang, 550004, P. R. China;
2. School of Nursing, Guizhou Medical University, Guiyang, 561113, P. R. China;
3. Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guizhou Medical University, Guiyang, 550004, P. R. China;
4. School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, P. R. China;

Corresponding?author：

YAO Li, Email: liyao5452@126.com

Keywords：

Telemedicine; heart failure; readmission rate; mortality rate; quality of life; self-care ability; effectiveness; systematic review/meta-analysis

DOI：

10.7507/1007-4848.202511072

Video：

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Objective To systematically evaluate the efficacy of telemedicine on patients with chronic heart failure. Methods We performed a computerized search of Web of Science, Embase, PubMed, Cochrane Library, China Biomedical Database (SinoMed), CNKI, Wanfang, and VIP databases for studies regarding telemedicine interventions for patients with chronic heart failure from their inception to November 5, 2025. Two reviewers independently conducted study screening, and data extraction. Risk of bias assessment for the included studies was performed using the Cochrane ROB 2.0 tool. Meta-analysis was performed using Review Manager 5.3 and Stata 17.0 software. Results A total of 39 randomized controlled trials (RCTs) involving 13 979 patients were included. All studies were rated as Grade A or B. The meta-analysis results showed that the intervention group had significantly lower rates of all-cause readmission [OR=0.63, 95%CI (0.50, 0.80), P<0.001], heart failure-related readmission [OR=0.50, 95%CI (0.38, 0.64), P<0.001], cardiovascular-related readmission [OR=0.55, 95%CI (0.38, 0.79), P=0.001], and heart failure-related mortality [OR=0.69, 95%CI (0.55, 0.88), P=0.003] compared to the control group. The quality of life [SMD=–1.05, 95%CI (–1.61, –0.49), P<0.001] and self-care ability [SMD=–1.53, 95%CI (–2.19, –0.86), P<0.001] in the intervention group were significantly better than those in the control group. There was no statistically significant difference in all-cause mortality between the two groups (P>0.05). Conclusion Telemedicine interventions can effectively reduce readmission rates and heart failure-related mortality in patients with chronic heart failure and have a positive effect on improving their quality of life and self-care ability. However, it has no significant effect on all-cause mortality. More large-sample RCTs with long-term follow-up are needed to further validate the impact of telemedicine on all-cause mortality in patients with heart failure.

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1. Mcdonagh TA, Metra M, Adamo M, et al. 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J, 2021, 42(36): 3599-3726.
2. 王華, 梁延春. 中國心力衰竭診斷和治療指南2018. 中華心血管病雜志, 2018, 46(10): 760-789.Wang H, Liang YC. Chinese guidelines for the diagnosis and treatment of heart failure 2018. Chin J Cardiol, 2018, 46(10): 760-789.
3. Neto MC, Duraes AR, Concei??o LSR, et al. High intensity interval training versus moderate intensity continuous training on exercise capacity and quality of life in patients with heart failure with reduced ejection fraction: a systematic review and meta-analysis. Int J Cardiol, 2018, 261: 134-141.
4. Taylor R, Long LD, Mordi IR, et al. Exercise-based rehabilitation for heart failure: Cochrane systematic review, meta-analysis, and trial sequential analysis. JACC Heart Fail, 2019, 7(8): 691-705.
5. Mounsey LA, Guo M, Lau ES, et al. Exercise training in heart failure: clinical benefits and mechanisms. Circ Res, 2025, 137(2): 273-289.
6. Tomasoni D, Adamo M, Lombardi CM, et al. Highlights in heart failure. ESC Heart Fail, 2019, 6(6): 1105-1127.
7. Varghese SK, Francis T, Shah JZ, et al. Multidisciplinary initiative to reduce 30-day readmissions in heart failure: a quality improvement perspective. BMJ Open Qual, 2025, 14(3): e003382.
8. Park C, Otobo E, Ullman J, et al. Impact on readmission reduction among heart failure patients using digital health monitoring: feasibility and adoptability study. JMIR Med Inform, 2019, 7(4): 437-447.
9. Giordan LB, Tong HL, Atherton JJ, et al. The use of mobile apps for heart failure self-management: systematic review of experimental and qualitative studies. JMIR Cardio, 2022, 6(1): e33839.
10. Knoll K, Rosner S, Gross S, et al. Combined telemonitoring and telecoaching for heart failure improves outcome. NPJ Digit Med, 2023, 6(1): 193.
11. Zaman S, Padayachee Y, Shah M, et al. Smartphone-based remote monitoring in heart failure with reduced ejection fraction: retrospective cohort study of secondary care use and costs. JMIR Cardio, 2023, 7: e45611.
12. Cao GL, Fan C, Liu Y, et al. A telehealth program benefits discharged patients with heart failure. Acta Cardiol, 2023, 78(2): 195-202.
13. Liu QQ, Jiang CM, Xu XJ, et al. The clinical effect of WeChat-based MUST education model on patients with chronic heart failure. Ann Noninvasive Electrocardiol, 2022, 27(6): e13004.
14. 李佳璐, 李玲玲, 馬新萍, 等. Cochrane偏倚風險評估工具(RoB 2.0)的介紹及示范性應用. 中華現代護理雜志, 2023, 29(22): 2951-2956.Li JL, Li LL, Ma XP, et al. Introduction and demonstration application of Cochrane risk of bias 2 (RoB 2.0). Chin J Mod Nurs, 2023, 29(22): 2951-2956.
15. 歐陽彩云, 王芳, 翟曉樂. 電話隨訪對慢性心力衰竭患者再次住院率和生活質量的影響. 江西醫藥, 2022, 57(11): 1962-1963, 1967.Ouyang CY, Wang F, Zhai XL. The influence of telephone follow-up on the readmission rate and quality of life of patients with chronic heart failure. Jiangxi Med J, 2022, 57(11): 1962-1963, 1967.
16. 高俊峰, 顓孫程程, 李方, 等. 基于微信平臺的延續性護理對慢性心力衰竭患者康復的影響. 中國慢性病預防與控制, 2018, 26(11): 861-863.Gao JF, Zhuansun CC, Li F, et al. The impact of continuous nursing based on wechat platform on the rehabilitation of patients with chronic heart failure. Chin J Prev Control Chronic Dis, 2018, 26(11): 861-863.
17. 陳卓芳, 林雪英, 梁菊艷. 電話隨訪式延續性護理對慢性心力衰竭患者自我護理行為及生活質量的影響. 臨床護理雜志, 2018, 17(1): 24-26.Chen ZF, Lin XY, Liang JY. The influence of telephone follow-up continuous nursing on self-care behaviors and quality of life of patients with chronic heart failure. J Clin Nurs, 2018, 17(1): 24-26.
18. 李霞, 楊蕊, 田亞麗, 等. 基于微信的延續性護理在慢性心力衰竭患者中的應用. 中華現代護理雜志, 2021, 27(10): 1350-1354.Li X, Yang R, Tian YL, et al. Application of WeChat-based transitional care in patients with heart failure. Chin J Mod Nurs, 2021, 27(10): 1350-1354.
19. Asch DA, Troxel AB, Goldberg LR, et al. Remote monitoring and behavioral economics in managing heart failure in patients discharged from the hospital: a randomized clinical trial. JAMA Intern Med, 2022, 182(6): 643-649.
20. GESICA Investigators. Randomised trial of telephone intervention in chronic heart failure: DIAL trial. BMJ, 2005, 331(7514): 425.
21. Oscalices MIL, Okuno MFP, Lopes MCBT, et al. Discharge guidance and telephone follow-up in the therapeutic adherence of heart failure: randomized clinical trial. Rev Lat Am Enfermagem, 2019, 27: e3159.
22. Dorsch MP, Farris KB, Rowell BE, et al. The effects of the ManageHF4Life mobile app on patients with chronic heart failure: randomized controlled trial. JMIR Mhealth Uhealth, 2021, 9(12): e26185.
23. Achury-Salda?a DM, Gonzalez RA, Garcia A, et al. Efficacy of a telemonitoring system as a complementary strategy in the treatment of patients with heart failure. CIN Comput Inform Nurs, 2024, 42(7): 522-529.
24. Schwarz KA, Mion LC, Hudock D, et al. Telemonitoring of heart failure patients and their caregivers: a pilot randomized controlled trial. Prog Cardiovasc Nurs, 2008, 23(1): 18-26.
25. Mizukawa M, Moriyama M, Yamamoto H, et al. Nurse-led collaborative management using telemonitoring improves quality of life and prevention of rehospitalization in patients with heart failure: a pilot study. Int Heart J, 2019, 60(6): 1293-1302.
26. Boyne JJJ, Vrijhoef HJM, Crijns HJGM, et al. Tailored telemonitoring in patients with heart failure: results of a multicentre randomized controlled trial. Eur J Heart Fail, 2012, 14(7): 791-801.
27. Frederix I, Vanderlinden L, Verboven AS, et al. Long-term impact of a six-month telemedical care programme on mortality, heart failure readmissions and healthcare costs in patients with chronic heart failure. J Telemed Telecare, 2019, 25(5): 286-293.
28. Chaudhry SI, Mattera JA, Curtis JP, et al. Telemonitoring in patients with heart failure. N Engl J Med, 2010, 363(24): 2301-2309.
29. Koehler F, Koehler K, Deckwart O, et al. Efficacy of telemedical interventional management in patients with heart failure (TIM-HF2): a randomised, controlled, parallel-group, unmasked trial. Lancet, 2018, 392(10152): 1047-1057.
30. Dang S, Karanam C, Gómez-Marín O, et al. Outcomes of a mobile phone intervention for heart failure in a minority county hospital population. Telemed J E Health, 2017, 23(6): 473-484.
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Latest ArticlesEffectiveness of telemedicine in patients with chronic heart failure: A systematic review and meta-analysis

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