Please select the eligibility criteria that correspond to the clinical trial below.
Title: Effectiveness and Cost-effectiveness of Telemedicine for Heart Failure: The Danish "TeleCare North" Pragmatic Randomized Trial
Brief Summary: There are two main aims in this study. The first objective is to evaluate whether a particular telehealth solution, in addition to standard treatment and care, lead to a significant decrease in the mortality and an increase in health related quality of life for patients suffering from Heart Failure that may benefit from telehealth compared with only standard treatment and care. The second objective is to examine the additional costs of the telehealth solution and assess whether this solution is a cost-effective way to care for patients with Heart Failure across patients and municipality districts.

It is hypothesized that telehealth care will increase patients quality adjusted life years compared to usual practice, since no difference in mortality and a higher health related quality of life is expected. Furthermore, it is hoped that there will be a 30% reduction in the number of admissions and readmissions to hospitals and a 30% reduction in the number of outpatient visits resulting in fewer costs for hospitals. However, it is uncertain as to whether these savings are offset by other costs such as more visits to general practitioners, community care or the implementation costs.


Options:
A: Inclusion Criteria:

* People have Internet access
* People have sufficient knowledge of the Dutch/German language, writing and reading skills
* People have completed cardiac rehabilitation treatment or have suffered from at least one cardiac disease/event in the last 6 months
* People received behavior lifestyle recommendations with regard to physical activity and fruit and vegetable consumption

Exclusion Criteria:

* People who do not want to sign the informed consent
* People with contraindications with regard to physical activity and fruit and vegetable intake
* People without Internet access
* People with insufficient abilities to use computer and Internet
* People with poor cognitive performance/dementia.
B: Inclusion Criteria:

* All heart failure patients that may benefit from telehealthcare.
* Participants are qualified for inclusion if they have been diagnosed with HF according to national guidelines and are NYHA classified 2,3, and 4.
* Patients must have a permanent residence and be motivated for using telehealthcare. \*Patients must have a landline or mobile phone and be able to speak Danish or they must live with a relative speaking Danish. Such that the relative must be able to help the patient in translating the information in the use of telehealthcare.

Exclusion Criteria:

* Patients without landline phone / mobile phone or GSM (Global System for Mobile Communications) coverage.
* Patients not able to understand Danish adequately to complete the questionnaires in the study or patients having a cognitive impairment.
* Comorbidity is not an exclusion criterion.
C: Inclusion Criteria:

* COPD new GOLD classification (B, C and D class) and a spirometry in the previous year and
* Systolic and/or diastolic CHF defined at least by an echocardiogram performed in clinical stability; II, III and IV New York Heart Association class and optimized drug therapy.
* Informed consent signed

Exclusion Criteria:

* Physical activity limitations caused by non-cardiac and/or pulmonary problems
* Obstructive Cardiomyopathies and/or myocarditis
* Non cardiac and/or pulmonary pathologies that would cause the death of the patient during the study
* Poor adherence and compliance of the patient
D: Inclusion Criteria:

* patients of either sex with any aetiology of left ventricular systolic HF \[as defined in the European Society of Cardiology (ESC) guidelines\]
* with a left ventricular ejection fraction (LVEF) ≤40% on echocardiography;
* in New York Heart Association (NYHA) class I, II or III;
* who are to have had a hospitalization incident, be stable clinically (a patient does not need intravenous medication or has not had therapy modified for at least 7 days);
* who has no contraindications to undergo cardiopulmonary exercise test and
* who are able to exercise using the new model of home-based telerehabilitation.

Exclusion Criteria:

* NYHA class IV;
* unstable angina;
* unstable clinical status
* a history of acute coronary syndrome within the last forty days in patients with LVEF ≤35%; percutaneous angioplasty (PCI) within the last 2 weeks, coronary artery bypass grafting within the last 3 months, or initiation of cardiac resynchronization therapy (CRT-P, CRT-D) and/or implantable cardioverter-defibrillator (ICD) or pacemaker within the last six weeks;
* lack of ICD, CRT-P or CRT-D therapy despite the indications for implantation according to ESC guidelines;
* intracardiac thrombus
* rest heart rate (HR) \>90/min,
* tachypnoea \>20 breaths per minute
* symptomatic and/or exercise-induced cardiac arrhythmia or conduction disturbances;
* acute myocarditis and/or pericarditis
* valvular or congenital heart disease requiring surgical treatment;
* hypertrophic cardiomyopathy;
* severe pulmonary disease;
* uncontrolled hypertension;
* anemia (haemoglobin \<11.0 g/dL);
* physical disability related to severe musculoskeletal or neurological problems;
* recent embolism;
* thrombophlebitis;
* acute or chronic inflammatory disease;
* acute or chronic decompensated non-cardiac diseases (thyreotoxicosis, uncontrolled diabetes)
* active malignant neoplastic diseases with survival prognosis below 2 - 5 years;
* orthotropic heart transplant in anamnesis;
* aortic aneurysm;
* severe psychiatric disorder; and
* patient's refusal to participate.

Answer: B