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 ) .
Impact of Home Patient Telemonitoring on Use of β-Blockers in Congestive Heart Failure
Abstract Introduction Congestive heart failure ( CHF ) , which typically affects older people , is characterized by high short- and mid-term mortality rates . However , despite accumulating evidence showing that administration of β-blockers ( β-adrenoceptor antagonists ) can improve the clinical status of CHF patients , use of these agents in adequate dosages in this setting is not routine . One reason for this appears to be a concern about a possible risk of bradyarrhythmia associated with use of β-blockers . Telecardiology has recently been investigated as a means of constantly monitoring the heart rate of CHF patients in their homes . Its use may allay concerns about the risk of bradyarrhythmia and facilitate a more widespread use of β-blockers in this context . Objectives The primary objectives of this study were to assess the impact of telemonitoring on patients ’ adherence to prescribed therapeutic regimens , particularly β-blockers , and to explore whether use of home telemonitoring reduces mortality and rate of re-admission to hospital in elderly CHF patients compared with normal specialized CHF team care . Methods A total of 57 patients with CHF ( 31 New York Heart Association [ NYHA ] class II , 23 NYHA class III and 3 NYHA class IV ) , with a mean ±SD age of 78.2±7.3 years , were r and omized to a control group who received st and ard care  , based on routinely scheduled clinic visits , from a team specialized in CHF patient management , or to a home telemonitoring group ( TM group )  , managed by the same specialized CHF team . Patients were followed up over 12 months . Results Compared with the control group , the TM group had a significant increase in the use of β-blockers , HMG-CoA reductase inhibitors ( statins ) and aldosterone receptor antagonists . A reduction in nitrate administration compared with baseline was also seen in the TM group . The 12-month occurrence of the primary combined endpoint of mortality and hospital re-admission for CHF was significantly lower in the TM group than in the control group ( p < 0.01 ) . Conclusions This study showed that a home-care model including telemonitoring of relevant clinical parameters may provide useful support in the management of patients with CHF . Home telemonitoring in CHF patients was associated with increased use of β-blockers at appropriate doses , suggesting that this strategy reassured physicians regarding the safety of careful use of these agents in this setting . However , larger studies are required to confirm these findings . Our findings indicate that there is a need to investigate relevant parameters in CHF patients at the point of care ( i.e. in patients ’ daily lives ) , which can in turn optimize β-blocker and other drug therapy
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 ) .