Impact of Telemedicine Technologies on Treatment Adherence in Patients with Chronic Heart Failure: a Systematic Review and Meta-Analysis

Aim    Analysis of literature on the effect of telemedicine technologies on the adherence of patients with chronic heart failure (CHF) to therapy at the outpatient stage of treatment.
Material and methods    Publications were searched for in PubMed, Web of Science, Scopus, CyberLeninka, and Google Scholar using the key terms "telemedicine technologies," "remote monitoring," "commitment to treatment," "mobile applications in treatment," "telemedicine," and "telemonitoring." Reports were selected (January 2015-January 2025) independently by two researchers who reached a consensus. Based on the selection of literature sources, four studies that met the search criteria were included in the meta-analysis. The analysis was performed with the Review Manager 5.4.1 and Comprehensive Meta-Analysis 3.0 software using the fixed-effects model (inverse variance method). The results were visualized using a forest plot. Heterogeneity assessment included the Q-test and the I2 index (criterion: <75%). Statistical significance was defined at p<0.05. The risk of bias was analyzed across 5 domains: randomization, protocol deviations, missing data, measurement, and results reporting.
Results    The overall adherence rate in the reviewed studies was 64.8% (79/122 patients) in the telemonitoring group and 59.2% (74/125 patients) in the standard observation group, for a total of 61.9% (153/247 patients). Thus, the relative risk of treatment adherence was 1.10 (95% confidence interval (CI) 0.91-1.33; p=0.33). When assessing the homogeneity of the studies with the Pearson’s chi-square test, a statistically non-significant result was obtained (Pearson’s chi-square 2.74 with a degree of freedom of 2, p=0.25), and the heterogeneity index I2=27%, which determines the low heterogeneity of the studies. To identify systematic errors in the studies that used telemonitoring and the standard approach, funnel plot data were accounted for, which indicated an asymmetric distribution of data.
Conclusion    Telemonitoring with mobile apps and wearable devices is beneficial for patient adherence to treatment. Active implementation of these technologies is required to improve the monitoring of the use of prescribed therapy by patients with CHF.

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