No favourable effect on mortality was observed with STS HM .
Similar reductions were observed in all-cause hospitalisations for TM interventions , whereas STS interventions had no major effect .
STS HM was dominated by usual care .
Similar results were observed in scenario analyses performed using higher costs of usual care , higher costs of STS HH and lower costs of TM during office hours .
As a result , the economic model developed scenarios for different RM classifications and their costs were estimated using bottom-up costing methods .
Despite wide variation in usual care and RM strategies , cost-effectiveness analyses suggest that TM during office hours was an optimal strategy ( in most costing scenarios ) .
However , clarity was lacking among descriptions of the components of RM packages and usual care and there was a lack of robust estimation of costs .
BACKGROUND Remote monitoring ( RM ) strategies have the potential to deliver specialised care and management to patients with heart failure ( HF ) .
OBJECTIVE To determine the clinical effectiveness and cost-effectiveness of home telemonitoring ( TM ) or structured telephone support ( STS ) strategies compared with usual care for adult patients who have been recently discharged ( within 28 days ) from acute care after a recent exacerbation of HF .
The review included r and omised controlled trials ( RCTs ) or observational cohort studies with a contemporaneous control group that included the following RM interventions : ( 1 ) TM ( including cardiovascular implanted monitoring devices ) with medical support provided during office hours or 24/7 ; ( 2 ) STS programmes delivered by human-to-human contact ( HH ) or human-to-machine interface ( HM ) .
Symptomatic and asymptomatic left-ventricular systolic dysfunction in an urban population
BACKGROUND In most previous epidemiological studies on the prevalence of chronic heart failure ( CHF ) the disorder has been defined on clinical criteria . In a cross-sectional survey of 2000 men and women aged 25 - 74 , r and omly sample d from one geographical area , we assessed left-ventricular systolic function by echocardiography . METHODS 1640 ( 83 % ) of those invited took part . They completed a question naire on current medication , history , and symptoms of breathlessness . Blood pressure  was measured and electrocardiography ( ECG ) and echocardiography were done .  Left-ventricular ejection fraction was measurable in 1467 ( 89.5 % ) participants by the biplane Simpson 's rate method . FINDINGS The mean left-ventricular ejection fraction was 47.3 % . The prevalence of definite left-ventricular systolic dysfunction ( defined as a left-ventricular ejection fraction < or = 30 % ) was 2.9 % overall ( 43 participants ) ; it increased with age and was higher in men than in women ( 4.0 vs 2.0 % ) . The left-ventricular systolic dysfunction was symptomatic in 1.5 % of participants and asymptomatic in 1.4 % , 83 % of participants with left-ventricular systolic dysfunction had evidence of ischaemic heart disease ( IHD ) from history or ECG criteria compared with 21 % of those without this abnormality ( p < 0.001 ) . Hypertension was also more common in those with left-ventricular systolic dysfunction ( 72 vs 38 % , p < 0.001 ) , but there was no difference between those with and without left-ventricular systolic dysfunction in the rate of hypertension without IHD . INTERPRETATION Left-ventricular systolic dysfunction was at least twice as common as symptomatic heart failure defined by clinical criteria . The main risk factors are IHD and hypertension in the presence of IHD ; screening of such high-risk groups for left-ventricular systolic dysfunction should be considered
No favourable effect on mortality was observed with STS HM .
Similar reductions were observed in all-cause hospitalisations for TM interventions , whereas STS interventions had no major effect .
STS HM was dominated by usual care .
Similar results were observed in scenario analyses performed using higher costs of usual care , higher costs of STS HH and lower costs of TM during office hours .
As a result , the economic model developed scenarios for different RM classifications and their costs were estimated using bottom-up costing methods .
Despite wide variation in usual care and RM strategies , cost-effectiveness analyses suggest that TM during office hours was an optimal strategy ( in most costing scenarios ) .
However , clarity was lacking among descriptions of the components of RM packages and usual care and there was a lack of robust estimation of costs .
BACKGROUND Remote monitoring ( RM ) strategies have the potential to deliver specialised care and management to patients with heart failure ( HF ) .
OBJECTIVE To determine the clinical effectiveness and cost-effectiveness of home telemonitoring ( TM ) or structured telephone support ( STS ) strategies compared with usual care for adult patients who have been recently discharged ( within 28 days ) from acute care after a recent exacerbation of HF .
The review included r and omised controlled trials ( RCTs ) or observational cohort studies with a contemporaneous control group that included the following RM interventions : ( 1 ) TM ( including cardiovascular implanted monitoring devices ) with medical support provided during office hours or 24/7 ; ( 2 ) STS programmes delivered by human-to-human contact ( HH ) or human-to-machine interface ( HM ) .