Ryan P. W. Kenny

Background: Algorithm-enabled remote monitoring using cardiac implantable electronic devices (CIEDs) is increasingly used to support earlier detection of clinical deterioration in heart failure and in at-risk populations. However, the economic value of these technologies remains uncertain because intervention design, implementation, and evaluation methods vary. Objective: This study aimed to systematically identify, appraise, and synthesize full economic evaluations of algorithm-enabled CIED remote monitoring in adults with established heart failure or at risk of heart failure. Methods: A systematic review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines. Searches were performed in MEDLINE, Embase, Scopus, Web of Science, and the Cochrane Library, with supplementary searches of health technology assessment sources. Eligible studies reported full economic evaluations of algorithm-enabled remote monitoring linked to CIEDs. Data were extracted using a structured form and synthesized narratively due to heterogeneity. Methodological and reporting quality were assessed using the CHEQUE (Criteria for Health Economic Quality Evaluation) checklist and CHEERS (Consolidated Health Economic Evaluation Reporting Standards) 2022 statement. One reviewer screened records and extracted the data. A second reviewer independently checked subsets of the screening decisions and extracted the data. Results: Ten economic evaluations were included. They used models, trial data, or observational data; some were reported within health technology assessments. Substantial heterogeneity was observed in population definitions, intervention characteristics, algorithm types, monitored parameters, clinical response pathways, and economic methods. Cost-effectiveness and cost-utility analyses were most common, with time horizons ranging from short-term follow-up to lifetime modeling. Several studies reported economically favorable findings, including dominance (ie, less costly with better health outcomes) or cost-effectiveness. However, outcomes varied across studies, and favorable estimates often relied on assumptions about reduced hospitalization and length of stay, while quality-adjusted life year gains were generally modest. Reporting of key implementation factors, including alert burden and diagnostic performance, was limited. Conclusions: There is economic evidence for algorithm-enabled CIED remote monitoring suggesting potential value in some settings, but the evidence remains methodologically heterogeneous and difficult to compare directly across studies. Findings are sensitive to differences in intervention design, modeling approaches, and clinical input data, which limit certainty and transferability. More robust and standardized evidence is needed before economic conclusions can be applied confidently across different devices, algorithms, and health care settings.

Background and Aims: There is a recognised association between inflammatory bowel disease (IBD) and lymphoma. However, the magnitude of lymphoma risk and impact of immunosuppression remain uncertain. Existing syntheses are limited by pooling of Crohn's disease (CD) and ulcerative colitis (UC) risk, conflation of disease‐ and treatment‐associated risk, and inclusion of overlapping registry populations. We aimed to evaluate the lymphoma risk in CD and UC in the published literature, including associations between immunosuppressive therapies and lymphoma. Methods: Systematic review and meta‐analysis of studies published between 01/01/2000 and 20/06/2025. Lymphoma risk was evaluated through narrative synthesis and multi‐level random‐effects meta‐analysis in population‐based studies of CD and UC, and studies of immunosuppression‐associated lymphoma in IBD. Certainty of evidence was assessed using GRADE. Results: Twenty‐five studies were included. Pooled relative risk of lymphoma was 3.32 (95% CI 1.80–6.13) in CD and 1.24 (95% CI 1.11–1.39) in UC. Childhood‐onset CD was associated with higher relative risk (4.23, 95% CI 2.07–8.65). Current thiopurine exposure was associated with lymphoma (RR 2.19, 95% CI 1.33–3.62) but confounding by indication limits interpretation and evidence for increasing relative risk with age is limited. Evidence for an independent association with advanced therapies was of very low certainty. Conclusions: These findings support disease‐specific risk stratification for CD and UC. Future studies should investigate immunosuppression‐associated risk in CD and UC separately and we caution against overinterpretation of pooled IBD risk estimates. Current evidence supports an association between thiopurines and lymphoma but does not support an independent association with advanced therapies. Trial Registration: This study was registered with PROSPERO (CRD420251027094)

Objectives To identify and synthesise evidence pertaining to ‘health check’ programmes for the assessment of cardiovascular risk factors and disease delivered to adult populations in countries with universal healthcare. Design A systematic umbrella review was undertaken. The protocol for this systematic umbrella review was registered on the PROSPERO registry and was undertaken based on Cochrane guidance and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. Data sources Medline, Embase, Cumulative Index of Nursing and Allied Health Literature (CINAHL), the Cochrane Database of Systematic Reviews, Scopus, Google Scholar and Health Management Information Consortium (HMIC) were searched. These searches identified records published between January 2009 and February 2025. Eligibility criteria The inclusion criteria for the review were as follows: population—adults aged ≥18 years; intervention—health checks including the assessment of cardiovascular risk factors and disease; comparators—non-recipients, variations of health checks and within-person pre/post assessments; outcomes—uptake and diagnosis rates, cardiovascular disease (CVD) and related clinical and behavioural risk factors, referral changes, and barriers and facilitators to uptake. Studies published prior to 2009 (when NHS Health Checks were introduced) and those from countries without universal healthcare provision were excluded. Screening was performed independently by two reviewers and conflicts were resolved via discussion or adjudication by a third reviewer. Data extraction and synthesis Data extraction and quality appraisal were performed independently by a single reviewer and checked by a second reviewer. The quality of included reviews was assessed using the Risk of Bias in Systematic Reviews (ROBIS) (for quantitative evidence) and the Swedish Agency for Medical and Social Evaluation tool (for qualitative evidence). The results of this systematic umbrella review were synthesised narratively. Results Results from meta-analyses reported by the included systematic reviews showed that the effects of health checks on cardiovascular and total mortality, stroke and coronary heart disease were mixed and generally non-significant. Conversely, health checks generally showed significant, positive effects (reductions) in CVD risk factors including blood pressure, body mass index and cholesterol levels. Non-significant reductions in smoking were found in two meta-analyses. Health checks were generally cost-effective; however, it was found that the cost-effectiveness of health checks could be improved through targeting towards ‘high risk’ populations defined based on socioeconomic factors, obesity and family history of CVD. Health check attendance versus non-attendance was related to demographic, attitudinal, socioeconomic and practical factors. The effectiveness of health checks was influenced by factors including social support to make changes to health behaviours and the availability and accessibility of referral options. Conclusions Overall, health checks had a positive impact on the detection of and improvement in the levels of cardiovascular risk factors. There was limited evidence of impact on the occurrence of longer term CVD events, which could reflect the limitations of onward treatment for CVD. Cardiovascular health checks could be more effective and cost-effective if targeted towards high-risk groups. The ability to access appointments at convenient times and venues and increased opportunities for social support may increase health check uptake, and increased availability and accessibility of referral options may improve their effectiveness. PROSPERO registration number CRD42024487529.

Background: Cardiac implantable electronic devices (CIEDs) are crucial in managing various cardiac conditions, but their monitoring poses considerable challenges. Algorithm-enabled remote monitoring of these devices has emerged as a promising solution to enhance patient outcomes and potentially reduce health care expenditures; however, its economic impact remains underexplored. Objective: This systematic review protocol aims to review and synthesize the existing evidence on the cost-effectiveness and cost-utility of algorithm-enabled remote monitoring for CIEDs in patients with or at risk of heart failure. Methods: The search of literature will be performed in MEDLINE, Embase, Scopus, Web of Science, and the Cochrane Library, with supplementary searches in the National Health Service Economic Evaluation Database, the National Institute for Health and Care Excellence, the Canadian Agency for Drugs and Technologies in Health, the International Network of Agencies for Health Technology Assessment, and the National Institute for Health and Care Research. This protocol is reported in accordance with the PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols) 2015 statement, and the completed review will be reported following the PRISMA 2020 statement. Results: Following database searching and deduplication, 3108 records were retrieved; 731 (23.5%) duplicates were removed, leaving 2377 (76.5%) records for title and abstract screening. The review will identify and synthesize economic evaluations of algorithm-enabled remote monitoring in adults with CIEDs, summarizing reported costs, outcomes, and cost-effectiveness results. Methodological quality, risk of bias, and sources of heterogeneity across studies will be assessed. Conclusions: The findings of this review may help inform health care providers, policymakers, and other stakeholders by clarifying the current economic evidence on these monitoring systems, informing adoption decisions, and identifying areas requiring further research.

Background: Depression is associated with increased mortality, with underlying causes unclear. We conducted a systematic review and meta-analysis of cardiovascular (CV) mortality in depression and how antidepressant treatments and comorbidities modify this. Methods: We searched Medline, Embase, Scopus, Web of Science and Cochrane registers (inception to 31 December 2024) for randomised controlled trials (RCTs) and observational studies comparing CV mortality in adults with depression vs without, and receiving antidepressants vs controls. We excluded studies with k = 26), depression was associated with a significantly higher CV mortality versus no-depression (hazard ratio (HR): 1.45, 95% CI: 1.25–1.69). Effects were similar in non-selected community-dwelling cohorts and those with CV disease or type 2 diabetes. Antidepressants overall were associated with increased CV mortality in cohorts but after adjustment only tricyclic antidepressants (TCAs) had significantly increased risk vs no antidepressant ( k = 4; HR: 1.27, 95% CI: 1.02–1.58). RCT findings were directionally consistent but underpowered. Conclusions: Depression is associated with increased risk of CV mortality irrespective of comorbid group studied. Antidepressants do not appear to modify this risk, apart from TCAs, which may increase it. The antidepressant models in particular had high heterogeneity, reflecting a knowledge gap on the long-term effects of antidepressants in patients with depression on CV mortality.

Conference abstracts are commonly included in systematic reviews of evidence. Due to limitations in word count, conference abstracts often lack data or information. This causes issues for the assessment of risk of bias (RoB). We therefore aimed to compare the RoB rating, using the Cochrane RoB tool, for abstracts and full texts. This was accomplished using previously published Cochrane reviews and comparing RoB ratings for included studies originally included as an abstract and later as full text. To accomplish this, we searched the Cochrane Database of Systematic Reviews for reviews with updates across numerous disciplines (depression, anxiety, surgical, Parkinson's disease, Alzheimer's disease, multiple sclerosis, motor neuron disease, cancer, cardiovascular disease, and musculoskeletal disease). We identified 29 reviews, with 52 randomized controlled trials included, which had an abstract and subsequent full text available. If abstracts and full texts were not assessed using the Cochrane RoB tool, we obtained the texts and performed the assessment ( n = 32). To assess the likelihood of changing the domain assessment rating (low, unclear, or high) from conference abstract to full text, we performed a Bayesian categorical multinomial model for each domain (i.e., signaling question) of the Cochrane tool. At the abstract assessment stage, the most common decision was unclear. Using unclear as the reference level in the model led to increased odds of being rated high at full text, compared to abstract assessment, for domains 2 (allocation concealment: odds ratio [OR] = 3.09, 95% credible intervals (CrI) 1.01 to 9.84) and 3 (blinding: OR = 5.09, 95% CrI 1.67 to 16.20). Domain 2 also had odds of being rated low (OR: 2.93, 95% CrI: 1.13 to 7.87). This suggests an impact of changing conference abstract to full text assessments on RoB. The numerous unclear ratings observed at the abstract assessment were usually due to a lack of reporting. While the findings of this study should be interpreted within the context of small numbers, the evidence still suggests that, in some instances, such as allocation concealment and blinding, it is likely that the decision could change based on full‐text assessment. This also has implications for the certainty of the evidence, which is impacted by the RoB assessments, with having abstracts only or full texts available potentially changing the overall certainty. Current RoB tools may not be suitable for assessing conference abstracts.