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 ) .
Application of implantable hemodynamic monitoring in the management of patients with diastolic heart failure: a subgroup analysis of the COMPASS-HF trial.
BACKGROUND Nearly half of all patients with chronic heart failure ( HF ) have a normal ejection fraction ( EF ) , and abnormal diastolic function ( ie , diastolic heart failure [ DHF ] ) . However , appropriate management of DHF patients remains a difficult and uncertain challenge . METHODS AND RESULTS The Chronicle Offers Management to Patients with Advanced Signs and Symptoms of Heart Failure ( COMPASS-HF ) trial was design ed to evaluate whether an implantable hemodynamic monitor ( IHM ) was safe and effective in reducing the number of heart failure-related events ( HFRE ) in patients with chronic HF . The current study presents data on a prespecified and planned subgroup analysis from the COMPASS-HF trial : 70 patients with an EF > or = 50 % ( ie , DHF ) . As such , this represents a subgroup analysis of the COMPASS-HF Trial . DHF patients were r and omized  to IHM-guided care ( treatment ) vs. st and ard care ( control ) for 6 months . All 70 patients received optimal medical therapy , but the hemodynamic information from the IHM was used to guide patient management only in the treatment group . The HFRE rate in DHF patients r and omized to treatment was 0.58 events/6 months compared with DHF patients r and omized to control , which was 0.73 events/6 months ; this represented a 20 % nonsignificant reduction in the overall HFRE rate in the treatment group ( 95 % CI = -46 , 56 , P = .66 ) . There was a 29 % nonsignificant reduction in the relative risk of a HF hospitalization in the DHF patients r and omized to treatment compared with DHF patients r and omized to control ( 95 % CI = -69 , 70 , P = .43 ) . CONCLUSIONS The IHM was shown to be safe and was associated with a very low system-related and procedure-related complication rate in DHF patients . However , in this subgroup analysis limited to 70 DHF patients , the addition IHM-guided care did not significantly lower the rate of HFR events . The results of this subgroup analysis in DHF patients , for whom there are currently no proven , effective management strategies , will be used to design future studies defining the effects of IHM-guided care in patients with DHF
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 ) .