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 ) .
Utilization of telemedicine by heart disease patients following hospitalization
Summary NYHA class III and IV chronic heart failure has been established as a potential indication for telemedical care and monitoring already . We conducted a prospect i ve study to assess the utilization of telemedical services by cardiac patients in order to identify further indications . A total of 540 patients ( mean age 59 years ) with various heart diseases participated for at least 30 days in a home-based telemedicine service programme .  The two primary outcome measures were the rates of symptom-driven telephone calls ( A ) and ECG transmissions ( B ) per patient-year . The total follow-up was 68,649 days , with a median of 93 days . Symptomatic patients placed 713 calls and transmitted 221 ECGs . Poisson regression analysis with subset selection yielded four significant ( P < 0.05 ) independent positive predictors of the use of the telemedicine service : ( 1 ) recent repeat ( at least one previous ) percutaneous coronary intervention  ( A , P = 0.010 ; B , P = 0.001 ) ; ( 2 ) recent cardioversion for atrial fibrillation or flutter ( A , P < 0.0001 ; B , P < 0.0001 ) ; ( 3 ) ejection fraction ( A , P = 0.012 ; B , P > 0.05 ) ; and ( 4 ) reciprocal of age ( A , P < 0.0001 ; B , P > 0.05 ) . These data suggest that telemedicine may benefit patients following repeat percutaneous coronary intervention or cardioversion for atrial fibrillation . Since patients availed themselves of telemedicine service less with deteriorating ejection fraction and increasing age , individuals with chronic heart failure will need dedicated programmes , especially when they are older
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 ) .