The Impact of Digital Health on Hospitalization and Mortality in Heart Failure Patients in Low-and-Middle Income Countries (LMICs): A Systematic Review & Meta-Analysis

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ID: 321882
2026
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Abstract
Abstract Background 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 LMICs. Objective 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 Six databases were searched from January 1, 1990, to June 11, 2025. A total of 3,524 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 tool (RoB 2). Results Fifteen RCTs (N=4,568) 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% NYHA class III–IV. Random-effects meta-analysis showed dHealth reduced all-cause hospitalizations (RR 0.73, 95% 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). Conclusions dHealth 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.
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Authors Preston N. Nicely, Emily Eichstaedt, Charles Heald, Jack Simmons, Shiv Ishpujani, Stephen Clarkson
Journal European Heart Journal - Digital Health
Year 2026
DOI
10.1093/ehjdh/ztag117
URL
https://doi.org/10.1093/ehjdh/ztag117
Keywords Keywords not found

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