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 ) .
Sensitivity and positive predictive value of implantable intrathoracic impedance monitoring as a predictor of heart failure hospitalizations: the SENSE-HF trial.
AIMS Early recognition of impending decompensation and timely intervention may prevent heart failure ( HF ) hospitalization . We investigated the performance of OptiVol ® intrathoracic fluid monitoring for the prediction of HF events in chronic HF patients newly implanted with a device ( implantable cardioverter-defibrillator with or without cardiac resynchronization therapy ) . METHODS AND RESULTS SENSE-HF was a prospect i ve , multi-centre study that enrolled 501 patients . Phase I ( double blinded , 6 months ) determined the sensitivity and positive predictive value ( PPV ) of the OptiVol data in predicting HF hospitalizations . Of 58 adjudicated HF hospitalizations that occurred during the first 6 months in Phase I , 12 were predicted by OptiVol ( sensitivity = 20.7 % ) . Sensitivity appeared to be dynamic in nature and at the end of Phase I , had increased to 42.1 % . With 253 OptiVol detections , PPV for Phase I was 4.7 % . Phase II/III ( unblinded , 18 months ) determined the PPV of the first OptiVol Patient Alert for detection of worsening HF status with signs and /or symptoms of pulmonary congestion . A total of 233 patients noted such an OptiVol alert and for 210 , HF status was evaluated within 30 days . Heart failure status had worsened for 80 patients ( PPV = 38.1 % ) . CONCLUSIONS An intrathoracic impedance-derived fluid index had low sensitivity and PPV in the early period after implantation of a device in chronic HF patients  . Sensitivity improved within the first 6 months after implant . Further studies are needed to assess the place of this monitoring technology in the clinical management of patients with HF
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 ) .