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 ) .
Design of the Multi-Sensor Monitoring in Congestive Heart Failure (MUSIC) study: prospective trial to assess the utility of continuous wireless physiologic monitoring in heart failure.
BACKGROUND Remote monitoring of heart failure ( HF ) patients may help in the early detection of acute HF decompensation before the onset of symptoms . Appropriate early intervention in these patients may reduce HF-related hospitalizations and costs . METHODS The MUSIC ( Multi-Sensor Monitoring in Congestive Heart Failure ) study comprises 2 multicenter nonr and omized phases ( MUSIC-Development and MUSIC-Validation ) design ed to develop and vali date an algorithm for the prediction of acute HF decompensation using multiple physiologic signals obtained from an external , adherent , multisensor system capable of intermittent transmission of physiologic signals . Data obtained from MUSIC-Development will be used to develop the algorithm to predict HF decompensation . The algorithm will be vali date d in MUSIC-Validation with the objectives of ≥ 60 % sensitivity for correctly predicting an acute HF event , a false-positive patient status signal rate of ≤ 1.0 per patient-year , and a safety endpoint of ≤ 5 % of patients experiencing significant adverse skin conditions related to the prolonged wearing of the adherent device . A total of 542 patients in New York Heart Association functional class III-IV HF , with ejection fraction ≤ 40 % and a recent HF admission , are enrolled in MUSIC-Development ( n = 180 ) and MUSIC-Validation ( n = 362 ) . All patients are remotely monitored for 90 days using the Corventis multisensor system that transmits bioimpedance , electrocardiogram , and accelerometer data . RESULTS The MUSIC study has completed patient enrollment and follow-up in both phases . Once algorithm development is complete from the MUSIC-Development phase , the sequestered data set from the MUSIC-Validation phase will be used for algorithm validation
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 ) .