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 ) .
Ongoing right ventricular hemodynamics in heart failure: clinical value of measurements derived from an implantable monitoring system.
OBJECTIVES This study examined the characteristics of continuously measured right ventricular ( RV ) hemodynamic information derived from an implantable hemodynamic monitor ( IHM ) in heart failure patients . BACKGROUND Hemodynamic monitoring might improve the day-to-day management of patients with chronic heart failure ( CHF ) . Little is known about the characteristics of long-term hemodynamic information in patients with CHF or how such information relates to meaningful clinical events . METHODS Thirty-two patients with CHF received a permanent RV IHM system similar to a single-lead pacemaker .  Right ventricular systolic and diastolic pressures , heart rate , and pressure derivatives were continuously measured for nine months without using the data for clinical decision-making or management of patients . Data were then made available to clinical providers , and the patients were followed up for 17 months . Pressure characteristics during optimal volume , clinical ly determined volume-overload exacerbations , and volume depletion events were examined . The effect of IHM on hospitalizations was examined using the patients ' historical controls . RESULTS Long-term RV pressure measurements had either marked variability or minimal time-related changes . During 36 volume-overload events , RV systolic pressures increased by 25 + /- 4 % ( p < 0.05 ) and heart rate increased by 11 + /- 2 % ( p < 0.05 ) . Pressure increases occurred in 9 of 12 events 4 + /- 2 days before the exacerbations requiring hospitalization . Hospitalizations before using IHM data for clinical management averaged 1.08 per patient year and decreased to 0.47 per patient-year ( 57 % reduction , p < 0.01 ) after hemodynamic data were used . CONCLUSIONS Long-term ambulatory pressure measurements from an IHM may be helpful in guiding day-to-day clinical management , with a potentially favorable impact on CHF hospitalizations
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 ) .