Telemonitoring and telecare in cardiovascular diseases: a systematic review and meta-analysis of randomized controlled trials

Abstract Introduction Cardiovascular diseases (CVDs) remain the leading cause of morbidity and mortality worldwide, imposing a significant burden on patients and healthcare systems. Traditional models of follow-up often fail to provide continuous monitoring. Telemonitoring (TM) and telecare (TC) have emerged as innovative strategies to enhance disease management, facilitating timely medical interventions. Several randomized controlled trials (RCTs) have investigated the impact of these interventions compared to standard care, reporting potential benefits in reducing hospitalizations, improving quality of life, and optimizing outcomes. This systematic review and meta-analysis aims to provide an evaluation of the efficacy and safety of TM/TC versus standard care in patients with CVDs, based on evidence from RCTs. Methods We systematically searched the EMBASE, PubMed, and Cochrane databases to identify RCTs comparing TM/TC versus usual care in patients with CVD for a follow-up duration of 6–18 months. The primary outcome was cardiovascular mortality; secondary outcomes were all-cause mortality, all-cause rehospitalization, cardiovascular admissions, and heart failure admissions. Heterogeneity was assessed using I 2 analysis, and all statistical analyses were performed using R software version 4.4.1 and a random-effects model with the package “meta.” Results Our meta-analysis included data from 15 RCTs, encompassing a total of 8043 patients with CVDs, of whom 3946 were undergoing TC or other TM interventions. TM/TC were associated with statistically significant improvement in cardiovascular causes of mortality (hazard ratio [HR] 0.73; 95% confidence interval [CI] 0.56–0.95; p = 0.021; I 2 = 49.6%), all-cause mortality (HR 0.895; 95% CI 0.80–0.99; p = 0.043; I 2 = 0%), and all-cause rehospitalization (HR 0.72; 95% CI 0.60–0.85; p < 0.001; I 2 = 68.4%). Cardiovascular admissions and heart failure admissions were not statistically significant, with an odds ratio (OR) of 1.28 (95% CI 0.32–5.12; p = < 0.0001; I 2 = 93%) and 0.74 (95% CI 0.55–1.01; p < 0.0001; I 2 = 69.5%). Conclusion TM and TC were associated with significant reductions in mortality and rehospitalization among patients with CVDs, reinforcing their role as valuable adjuncts to standard care. These findings support the integration of digital health strategies into routine clinical practice. Nonetheless, the heterogeneity observed across studies underscores the need for well-designed, large-scale RCTs to identify patient subgroups most likely to benefit and to establish optimal implementation models.