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.

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.