Effect of clinical telemonitoring on treatment adherence in patients with heart failure: protocol for a systematic review of clinical trials

OBJECTIVES: To evaluate the effectiveness of telemonitoring on clinical outcomes in adult patients with heart failure, with an emphasis on treatment adherence, mortality, and hospital readmission, through a systematic review and meta-analysis of randomized clinical trials. METHODS: This is a systematic review protocol developed in accordance with the recommendations of the Cochrane Handbook for Systematic Reviews of Interventions and reported following the PRISMA-P guidelines. The protocol was registered on the PROSPERO platform (CRD420251181047). Randomized clinical trials evaluating telemonitoring interventions in adults with heart failure and reduced (HFrEF) or preserved (HFpEF) left ventricular ejection fraction will be included. Searches will be conducted in the MEDLINE (PubMed), Cochrane CENTRAL, Embase, Scopus, Web of Science, LILACS, CINAHL, and PsycINFO databases, without language or publication date restrictions. Two independent reviewers will perform study selection, data extraction, and risk of bias assessment using the RoB 2.0 tool. The certainty of evidence will be assessed using the GRADE approach. When appropriate, data will be synthesized through meta-analysis using a random-effects model. RESULTS: This systematic review is expected to compile and synthesize the best available evidence regarding the effectiveness of telemonitoring in patients with heart failure, identifying its impact on treatment adherence, mortality, and hospital readmission. It is also expected to identify which telemonitoring modalities and intervention components are associated with better clinical outcomes, as well as to highlight existing gaps in the scientific literature. CONCLUSIONS: The findings of this review may provide robust evidence to support evidence-based clinical practice, inform decision-making in digital health, and guide the development and implementation of technologies aimed at cardiovascular care. Furthermore, this study is expected to contribute to the optimization of heart failure management and to the strengthening of more efficient and patient-centered models of care.