The impact of digital health on hospitalization and mortality in heart failure patients in low- and middle-income countries: a systematic review and meta-analysis
In brief
Digital health cuts heart-failure hospitalizations by about a quarter in low-income countries
A meta-analysis of 15 randomized trials in Brazil, China, Thailand and other LMICs found that mobile apps, telemonitoring or wearables reduced all-cause hospital admissions by roughly 27% and heart-failure admissions by 30%, with a modest 14% drop in overall mortality. The effect on death specifically from heart failure was unclear, highlighting the need for larger trials to confirm survival benefits.
- Journal
- European heart journal. Digital health (Q1)
- Published
- 22 July 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Preston Nicely, Emily Eichstaedt, Charles Heald, Jack Simmons, Shiv Ishpujani, Stephen Clarkson
- PMID
- 42568654
- DOI
- 10.1093/ehjdh/ztag117
Why clinicians should know about it
- Picked for Cardiology and Cardiovascular Medicine (top studies of the week, 9 August 2026): Digital health reduces HF hospitalizations in LMICs
- Picked for Epidemiology (top studies of the week, 9 August 2026).
- Picked for Family Practice (top studies of the week, 9 August 2026).
Abstract
AIM: Heart disease is the leading cause of death worldwide, and the growing prevalence of heart failure (HF) is a key contributor. Digital health (dHealth) modalities including mobile applications, telehealth, and wearables have been developed to improve HF care, though little is known about their impact in low- and middle-income countries (LMICs). The aim of this review is to identify studies from LMICs that evaluated dHealth interventions for HF and determine the impact of those interventions on hospitalization and mortality. METHODS AND RESULTS: Six databases were searched from 1 January 1990 to 11 June 2025. A total of 3524 articles were screened (Cohen's κ = 69%). Included studies had a dHealth intervention, were a randomized controlled trial (RCT), occurred in a LMIC, and reported outcomes of interest. Risk of bias for RCTs was assessed using the Cochrane Risk of Bias 2 Tool. Fifteen RCTs (n = 4568) with studies in Brazil (33.3%), China (26.7%), and Thailand (13.3%) were included. Interventions included telemonitoring, mobile apps, and wearables. The population averaged 61.1 years, 31.4% female, and 45.7% New York Heart Association class III-IV. Random-effects meta-analysis showed dHealth reduced all-cause hospitalizations [risk ratio (RR) 0.73, 95% confidence interval (CI) 0.59-0.90], HF hospitalizations (RR 0.70, 95% CI 0.59-0.84), and all-cause mortality (RR 0.86, 95% CI 0.79-1.00); HF mortality was neutral (RR 0.64, 95% CI 0.37-1.11). CONCLUSION: Digital health in LMICs lowers hospitalizations and may reduce all-cause mortality, though the benefit for HF mortality remains uncertain. These findings support broader dHealth adoption in LMICs to address HF burden.PROSPERO registration number: CRD420251079715.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.