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 ) .
Home telemonitoring of vital signs and cardiorespiratory signals in heart failure patients: system architecture and feasibility of the HHH model.
BACKGROUND The Home or Hospital in Heart Failure Study ( HHH ) is a European Community funded trial ( QLGA-CT-2001 - 02424 ) which compares usual care of heart failure ( HF ) with three home-based interventions in a multicenter , multicountry ( Italy , Pol and and UK ) , r and omized controlled clinical trial . Home telemonitoring ( HT ) of clinical parameters represents a potential alternative ( or addition ) to traditional home care models . Nocturnal respiratory disorders ( periodic breathing , sleep apnea ) are very common in HF , and are associated with increased morbidity and mortality . We developed an integrated HT system for monitoring of both vital signs and respiration . All measurements were patient-managed . This paper describes the architecture of this system , and assesses its feasibility . METHODS AND RESULTS 461 clinical ly stable patients were r and omized first to usual vs home-monitored care ; the latter were further r and omized to 3 strategies . Over a 12-month follow-up 2 of these 3 groups ( 195 patients , age : 60+/-11 years , NYHA class II-III : 97 % , LVEF 28+/-7 % ) underwent self-administered home monitoring of vital signs ( weekly--12 parameters using an interactive voice response system ) and respiration ( monthly--24-hour recording ) . Data were transmitted over conventional telephone lines ; 81 % of actually practicable vital signs measurements were completed by the patients ( range : 75 % (PL)-93 % ( UK ) ) , as well as 92 % of practicable respiratory recordings ( range : 85 % (PL)-99 % ( UK ) ) . 87 % of nighttime recordings were eligible for the study ( good quality signals for > or = 2.5 h ) . CONCLUSIONS This study , the largest so far , demonstrates that self-managed home telemonitoring of both vital signs and respiration is feasible in HF patients , with surprisingly high compliance . We found an excellent rate of acceptable nocturnal respiratory recordings , which are those with the greatest clinical relevance
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 ) .