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 ) .
Continuous Monitoring of Intrathoracic Impedance and Right Ventricular Pressures in Patients With Heart Failure
Background —Hemodynamic monitoring using implantable devices may provide early warning of volume overload in patients with heart failure ( HF ) . This study was design ed to prospect ively compare information from intrathoracic impedance monitoring and continuous right ventricular pressure measurements in patients with HF . Methods and Results —Sixteen patients with HF ( age , 63.5±13.8 years ; left ventricular ejection fraction , 23.2±11.3 % ; New York Heart Association , II and III ) and a previous HF decompensation received both a cardiac resynchronization therapy defibrillator providing a daily average of intrathoracic impedance and an implantable hemodynamic monitor providing an estimate of the pulmonary artery diastolic pressure . At the end of a 6-month investigator-blinded period , baseline reference hemodynamic values were determined over 4 weeks during which the patient was clinical ly stable . A major HF event was defined as HF decompensation requiring hospitalization , IV diuretic treatment , or leading to death . Sixteen major HF events occurred in 10 patients . Within 30 days and 14 days before a major HF event , impedance decreased by 0.12±0.21 & OHgr;/d and 0.20±0.20 & OHgr;/d , respectively , whereas estimated pulmonary arterial diastolic pressure increased by 0.10±0.20 mm Hg/d and 0.16±0.15 mm Hg/d , respectively . During these periods , impedance decreased by 3.8±5.4 & OHgr ; ( P<0.02 ) and 4.9±6.1 & OHgr ; ( P<0.007 ) , respectively , whereas estimated pulmonary arterial diastolic pressure increased by 5.8±5.7 mm Hg ( P<0.002 ) and 6.8±6.1 mm Hg ( P<0.001 ) , respectively , compared with baseline . In all patients , impedance and estimated pulmonary arterial diastolic pressure were inversely correlated ( r=−0.48±0.25 ) . Within 30 days preceding a major HF event , this correlation improved to r=−0.58±0.24 . Conclusions —Decompensated HF develops based on hemodynamic derangements and is preceded by significant changes in intrathoracic impedance and right ventricular pressures during the month prior to a major clinical event . Impedance and pressure changes are moderately correlated . Future research may establish the complementary contribution of both parameters to guide diagnosis and management of patients with HF by implantable devices
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 ) .