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 ) .
Monitoring intrathoracic impedance with an implantable defibrillator reduces hospitalizations in patients with heart failure.
PURPOSE Some implantable cardioverter-defibrillators ( ICDs ) are now able to monitor intrathoracic impedance . The aim of the study was to describe the use of such monitoring in clinical practice and to evaluate the clinical impact of the fluid accumulation alert feature of these ICDs . METHODS AND RESULTS Five hundred thirty-two heart failure ( HF ) patients implanted with these ICDs  were followed up for 11 + /- 7 months . A clinical event ( CE ) was deemed to have occurred if it result ed in hospitalization or milder manifestations of HF deterioration . Three hundred sixty-two acute decreases in intrathoracic impedance ( Z events ) occurred in 230 patients . Of these episodes , 171 ( 47 % ) were associated with a CE within 2 weeks of the Z event . In another 71 ( 20 % ) Z events , drug therapy was adjusted despite the absence of overt signs of clinical deterioration . The rate of unexplained Z events was 0.25 per patient-year and 25 hospitalizations were not associated with Z events . The audible alert was disabled in a group of 102 patients ( OFF group ) .  HF hospitalizations occurred in 29 ( 7 % ) patients in the ON group and 20 ( 20 % , P < 0.001 ) patients in the OFF group . The rate of combined cardiac death and HF hospitalization was lower in patients with Alert ON ( log-rank test , P = 0.007 ) . CONCLUSIONS The ICD reliably detected CE and yielded low rates of unexplained and undetected events . The alert capability seemed to reduce the number of HF hospitalizations by allowing timely detection and therapeutic intervention
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 ) .