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 ) .
Impact of a comprehensive telephone-based disease management programme on quality-of-life in patients with heart failure.
BACKGROUND Disease management programmes for patients with heart failure have improving the quality -of-life ( QOL ) of patients with heart failure . METHODS Patients attending the heart failure clinic were r and omized into 2 groups of 25 patients each . The control group was managed in the heart failure clinic and the intervention group underwent the following additional interventions : ( i ) interactive sessions with the patient and spouse informing them about the disease , drugs , and self-management of fluid intake and diuretic dose ; ( ii ) a telephonic helpline was established and regular telephone calls made to reinforce the information and modify drug dosages . The QOL was assessed using the Kansas City Cardiomyopathy question naire . Functional capacity was assessed by the 6-minute walk test . Continuous variables were compared with the Student t-test ( paired or unpaired ) . RESULTS There was significant improvement in the QOL and functional capacity of patients in the intervention group compared with controls over a 6-month period . The mean ( SD ) QOL scores in the intervention group improved from 60.0 ( 23.6 ) to 76.3 ( 17.3 ) but did not change significantly in the control group ( 62.2 [ 22.6 ] to 63.4 [ 21.9 ] ) . There was a similar improvement in the functional capacity measured by the 6-minute walk test in the intervention group ( from 202.2 [ 81.5 ] to 238.1 [ 100.9 ] metres , p < 0.05 ) but not in the control group ( 193.8 [ 81.5 ] to 179.7 [ 112.0 ] metres ) . In the intervention group , the use of beta-blockers and angiotensin-converting enzyme inhibitors was similar but in the intervention group patients were placed on higher doses . There was no significant difference in the number of emergency room visits or admissions in either group . For every 20 patients in the intervention group , 14 patients improved by 1 functional class while in the control group this was observed in only 3 patients for every 20 treated . CONCLUSION This study demonstrates that in the setting of a developing country , improvement in QOL by intensive management of heart failure patients through a heart failure programme with telephonic reinforcement and a helpline is greater than that usually achieved with drug therapy in a routine heart failure clinic
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 ) .