The Effect of Telemedicine on Readmissions of Patients with Heart Failure and/or COPD: a Systematic Review

Abstract

Abstract Background Hospital readmissions pose a challenge for modern healthcare systems. Our aim was to assess the efficacy of telemedicine incorporating telemonitoring technologies in decreasing hospital readmissions with a focus on specific patient populations particularly prone to rehospitalization: patients with heart failure (HF) and/ or chronic obstructive pulmonary disease (COPD) through a systematic review. Methods Three major electronic databases, including PubMed, Scopus, and ProQuest’s ABI (Abstracted Business Information)/INFORM Global, were searched for trials employing telemedical technologies and quantifying the effect on the readmission rates in the HF and/or COPD populations. Our search was limited to English-language articles published between 2012 and 2022. Results Eighteen scientific articles referencing seventeen different clinical trials were isolated. Most studies were randomized controlled trials and the readmission related outcome most studied was all-cause readmissions followed by HF and acute exacerbation of COPD readmissions. 47% of the studies suggested that telemedicine might decrease the readmission related burden, while most of the remaining studies suggested that telemedicine had a neutral effect on hospital readmissions. Comparative analysis of studies focusing on the COPD or HF populations resulted in the observation of a clearer association in the reduction of the readmission-related burden in patients with COPD compared to patients with HF (83% vs 27%). Data regarding other relevant outcomes often assessed including all-cause mortality emergency department visits, healthcare costs, quality of life, medication adherence and reconciliation were extracted and qualitatively assessed. Conclusion This systematic review highlights the uncertainty surrounding the effectiveness of telemedicine in reducing the readmission rates of high-risk patients with chronic illnesses, with much of the uncertainty linked to the variability of the deliverable of telemedicine. Nonetheless, the fact that almost all trials found that patients receiving telemedicine benefited to some extent and the strong association in the reduction of readmissions in the COPD population are encouraging. Conduction of more high-quality studies is necessary to draw definitive conclusions.