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 ) .
A comparison of in-person home care, home care with telephone contact and home care with telemonitoring for disease management
We compared the effects of evidence -based disease management guidelines delivered to patients with heart failure and diabetes using three different modalities : in-person visits alone ( Control ) , in-person visits and a telephone intervention ( Telephone ) , and in-person visits and telemonitoring ( Telemonitoring ) .  Patients were r and omized to the three groups . There were 112 patients in the Control group , 93 in the Telephone group and 98 in the Telemonitoring group . During the first 60 days , 10 % of the Control group were rehospitalized , 17 % of the Telephone group and 16 % of the Telemonitoring group . Having heart failure and receiving more in-person visits were significantly related to readmission and time to readmission . However , after adjusting for diagnosis and visits , the differences between the three groups were non-significant . There was a trend for increased risk of readmission for the Telephone group compared to Control alone ( P = 0.07 , risk ratio 2.2 , 95 % CI : 0.9 to 5.2 ) and for readmission sooner ( P = 0.02 , risk ratio 2.3 , 95 % CI : 1.2 to 4.6 ) . Patient rehospitalization and emergency department visit rates were lower than the national average , making it difficult to detect a difference between groups . Previous rehospitalization was a consistent predictor of those who were rehospitalized , suggesting that it may be a useful indicator for identifying patients likely to need additional attention
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 ) .