Digital Health in Value-Based Cardiology and EP: Evidence, Gaps and Opportunities—A Systematic Review

Abstract Background Digital Health Technologies (DHTs) are increasingly embedded within VBHC frameworks to enhance outcomes and efficiency. In CV medicine, and particularly EP, they hold transformative potential through remote monitoring, AI and PROMs. Yet, evidence linking DHTs to measurable value remains fragmented Objective To systematically assess the role of DHTs as enablers of VBHC in cardiology and EP, identifying demonstrated benefits, evidence gaps and research priorities. Methods Following PRISMA 2020 (PROSPERO CRD420250650295), PubMed, ScienceDirect and Mendeley were searched (2017–2024) for English-language publications combining “digital health” and “value-based healthcare.” Studies meeting ≥2 criteria, VBHC focus, DHT assessment or value-oriented process analysis, were included. Data were synthesised across nine domains: electronic PROMs, mHealth, telemedicine, big data/AI and LHS. Results Sixty-two studies and twenty-three policy documents were included. Only 4 (6.5%) were RCTs. Eighteen studies (29%) addressed CV conditions, with EP as a key focus. DHTs demonstrated value via improved adherence, earlier AF detection, HF telemonitoring and PROM integration, though few quantified cost-effectiveness or QALYs. Evidence was heterogeneous and geographically uneven. Conclusions DHTs are pivotal enablers of value-based CV care, but robust outcome-linked evidence, especially in EP, remains limited. Wearables, telemonitoring and ePROMs illustrate measurable value, while AI-driven prediction and workflow optimisation are emerging frontiers. Future work should emphasise pragmatic trials, economic evaluations and standardised outcome metrics to reward digital value creation.

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Journal
European Heart Journal - Digital Health
Published
2026-08-20
DOI
https://doi.org/10.1093/ehjdh/ztag090
Primary Topic
Mobile Health and mHealth Applications
Type
article
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article

Digital Health in Value-Based Cardiology and EP: Evidence, Gaps and Opportunities—A Systematic Review

Helmut Pürerfellner, Deirdre A. Lane, Nikola Kozhuharov, Josep Figueras et al.
European Heart Journal - Digital Health
Mobile Health and mHealth Applications
article

Digital Health in Value-Based Cardiology and EP: Evidence, Gaps and Opportunities—A Systematic Review

Helmut Pürerfellner, Deirdre A. Lane, Nikola Kozhuharov, Josep Figueras, Haran Burri, Rubén Casado-Arroyo, Brendan Collins, José Luís Merino, Panos Vardas, Elena Arbelo, Davide Antonio Mei, Lucia Osoro, Giuseppe Boriani, Maura Zylla
article en

Abstract

Abstract Background Digital Health Technologies (DHTs) are increasingly embedded within VBHC frameworks to enhance outcomes and efficiency. In CV medicine, and particularly EP, they hold transformative potential through remote monitoring, AI and PROMs. Yet, evidence linking DHTs to measurable value remains fragmented Objective To systematically assess the role of DHTs as enablers of VBHC in cardiology and EP, identifying demonstrated benefits, evidence gaps and research priorities. Methods Following PRISMA 2020 (PROSPERO CRD420250650295), PubMed, ScienceDirect and Mendeley were searched (2017–2024) for English-language publications combining “digital health” and “value-based healthcare.” Studies meeting ≥2 criteria, VBHC focus, DHT assessment or value-oriented process analysis, were included. Data were synthesised across nine domains: electronic PROMs, mHealth, telemedicine, big data/AI and LHS. Results Sixty-two studies and twenty-three policy documents were included. Only 4 (6.5%) were RCTs. Eighteen studies (29%) addressed CV conditions, with EP as a key focus. DHTs demonstrated value via improved adherence, earlier AF detection, HF telemonitoring and PROM integration, though few quantified cost-effectiveness or QALYs. Evidence was heterogeneous and geographically uneven. Conclusions DHTs are pivotal enablers of value-based CV care, but robust outcome-linked evidence, especially in EP, remains limited. Wearables, telemonitoring and ePROMs illustrate measurable value, while AI-driven prediction and workflow optimisation are emerging frontiers. Future work should emphasise pragmatic trials, economic evaluations and standardised outcome metrics to reward digital value creation.

European Heart Journal - Digital Health
University of Bern (CH), University of Modena and Reggio Emilia (IT), Heart Rhythm Society (US), European Observatory on Health Systems and Policies (BE), Université Libre de Bruxelles (BE), University of Liverpool (GB), Heidelberg University (DE), Hospital Universitario La Paz (ES), University Hospital of Bern (CH), University Hospital Heidelberg (DE), Liverpool Heart and Chest Hospital (GB), Public Health Wales (GB), Biomedical Research Foundation of the Academy of Athens (GR), Centro de Investigación en Red en Enfermedades Cardiovasculares (ES), University Hospital of Geneva (CH), Azienda Ospedaliero-Universitaria di Modena (IT), Centro de Investigación Biomédica en Red (ES), Hospital Clínic de Barcelona (ES), Camilo José Cela University (ES), University Hospital of Heraklion (GR), ERN GUARD-Heart (NL), AGO Austria (AT), Consorci Institut D'Investigacions Biomediques August Pi I Sunyer (ES), Universitat de Barcelona (ES)
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Mobile Health and mHealth Applications
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