Differential Effects of Telehealth on Psychological Outcomes in Heart Failure: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

BACKGROUND

Heart failure (HF) represents a significant global health challenge. Individuals with HF commonly experience psychological issues, including depression and anxiety, which negatively affect quality of life (QoL) and clinical outcomes. While telehealth has been identified as a promising approach for chronic disease management, its effectiveness in enhancing psychological outcomes in HF remains unclear.

OBJECTIVE

To evaluate the effectiveness of telehealth interventions in improving psychological outcomes among individuals with HF.

METHODS

A systematic review and meta-analysis were conducted across six electronic databases (PubMed, Scopus, EBSCOhost, Springer Nature, Taylor & Francis, and Sage Journals). Methodological quality was evaluated with the JBI and RoB 2 tools. Pooled effects were reported as standardized mean differences (SMD) or mean differences (MD), applying fixed- or random-effects models based on heterogeneity (I2). Subgroup analyses were conducted by delivery model, intervention duration, and measurement tool. Publication bias was examined using funnel plots, Egger's test, and Begg's test.

RESULTS

26 RCTs were included, with 17 (n = 4,796) entered the meta-analysis. Telehealth showed no significant effect on QoL (SMD=-0.31; p=0.25; I2=98%) or depression (SMD= -0.65; p=0.07; I2= 96%), but were associated with a significant reduction in anxiety (SMD= -0.91; p=0.009; I2 = 94%). Subgroup analyses indicated that mobile applications significantly improved QoL (SMD= -0.92; p=0.01), while phone-call support significantly reduced depression (SMD= -1.28; p=0.02). Significant reductions in depression were also observed when using HADS (p=0.006) and BDI (p=0.010), and with follow-up >6 months (p=0.03).

CONCLUSION

Telehealth interventions significantly reduced anxiety among individuals with HF but demonstrated limited effects on depression and QoL. The presence of very high heterogeneity across all outcomes reduces the certainty of these findings and necessitates cautious interpretation. The effectiveness of telehealth as a psychological intervention may depend on specific design and implementation factors.