Digital Health in Value-Based Cardiology and EP: Evidence, Gaps and Opportunities—A Systematic Review

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Abstract Background Digital Health Technologies (DHTs) are increasingly embedded within VBHC frameworks to enhance outcomes and efficiency. In CV medicine, and particularly EP, they hold transformative potential through remote monitoring, AI and PROMs. Yet, evidence linking DHTs to measurable value remains fragmented Objective To systematically assess the role of DHTs as enablers of VBHC in cardiology and EP, identifying demonstrated benefits, evidence gaps and research priorities. Methods Following PRISMA 2020 (PROSPERO CRD420250650295), PubMed, ScienceDirect and Mendeley were searched (2017–2024) for English-language publications combining “digital health” and “value-based healthcare.” Studies meeting ≥2 criteria, VBHC focus, DHT assessment or value-oriented process analysis, were included. Data were synthesised across nine domains: electronic PROMs, mHealth, telemedicine, big data/AI and LHS. Results Sixty-two studies and twenty-three policy documents were included. Only 4 (6.5%) were RCTs. Eighteen studies (29%) addressed CV conditions, with EP as a key focus. DHTs demonstrated value via improved adherence, earlier AF detection, HF telemonitoring and PROM integration, though few quantified cost-effectiveness or QALYs. Evidence was heterogeneous and geographically uneven. Conclusions DHTs are pivotal enablers of value-based CV care, but robust outcome-linked evidence, especially in EP, remains limited. Wearables, telemonitoring and ePROMs illustrate measurable value, while AI-driven prediction and workflow optimisation are emerging frontiers. Future work should emphasise pragmatic trials, economic evaluations and standardised outcome metrics to reward digital value creation.

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