Clinical decision support systems for heart failure management optimization: A systematic review and meta-analysis of randomized controlled trials

Abstract

Background

Heart failure (HF) patients are frequently rehospitalized shortly after discharge. Telemonitoring and clinical decision support systems (CDSS) health alert follow-up may reduce the mortality and hospitalization in HF patients following discharge.

Methodology

We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) from PubMed, Web of Science, Scopus, Embase, and Cochrane Central Register of Controlled Trial until May 2024. Dichotomous data were pooled using risk ratio (RR) and continuous data using mean difference. This systematic review and meta-analysis was registered with PROSPERO ID: CRD42024555577.

Results

We included eight RCTs with a total of 7661 patients. Patients managed by CDSS were at lower risk of all-cause mortality than those who received usual care [RR: 0.64 with 95% confidence interval [CI] (0.45, 0.92), p = 0.01]. However, there was no difference in all-cause hospitalization [RR: 0.99 with 95% CI (0.88, 1.11), p = 0.84] between both groups. Additionally, CDSS led to a significant increase in mineralocorticoid antagonist (MRA) prescription compared to usual care [RR: 1.77 with 95% CI (1.48, 2.11), p < 0.00001], but there was no difference in addition of all-class guideline-directed medical therapy (GDMT) [RR: 1.23 with 95% CI (1.00, 1.52), p = 0.05] between the both groups.

Conclusion

Clinical decision support systems significantly reduced all-cause mortality and increased MRA prescription. Still, there was no difference in all-cause hospitalization and the addition of all-class GDMT. More robust studies with longer follow-ups are therefore required to thoroughly examine the efficacy of CDSS in optimizing HF management.