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 ) .
Prevalence of left-ventricular systolic dysfunction and heart failure in the Echocardiographic Heart of England Screening study: a population based study
BACKGROUND Accurate data for prevalence rates for heart failure due to various causes , and for left-ventricular systolic dysfunction in all adults are unavailable . Our aim was to assess prevalence of left-ventricular systolic dysfunction and heart failure in a large representative adult population in Engl and . METHODS Of 6286 r and omly selected patients aged 45 years and older , 3960 ( 63 % ) participated in the study . They came from 16 r and omly selected general practice s. We assessed patients by  history and examination , electrocardiography , and echocardiography .  Prevalence of left-ventricular systolic dysfunction ( defined as ejection fraction < 40 % ) and heart failure was calculated for the overall population on the basis of strict criteria and , when necessary , adjudication by a panel . FINDINGS Left-ventricular systolic dysfunction was diagnosed in 72 ( 1.8 % [ 95 % CI 1.4 - 2.3 ] ) participants , half of whom had no symptoms . Borderline left-ventricular function ( ejection fraction 40 - 50 % ) was seen in 139 patients ( 3.5 % [ 3.0 - 4.1 ] ) . Definite heart failure was seen in 92 ( 2.3 % , [ 1.9 - 2.8 ] ) and was associated with an ejection fraction of less than 40 % in 38 ( 41 % ) patients , atrial fibrillation in 30 ( 33 % ) , and valve disease in 24 ( 26 % ) . Probable heart failure was seen in a further 32 ( 0.8 % [ 0.6 - 1.1 ] ) patients . In total , 124 ( 3.1 % [ 2.6 - 3.7 ] ) patients aged 45 years or older had definite or probable heart failure . INTERPRETATION Heart failure is often misdiagnosed or underdiagnosed in primary care . Our results suggest that assessment of left-ventricular function in patients with suspected heart failure could lead to more effective diagnosis and treatment of this disorder
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 ) .