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 ) .
An intervention for VA patients with congestive heart failure.
OBJECTIVE To assess the effect of a telephone intervention to improve quality of life among patients with congestive heart failure ( CHF ) . STUDY DESIGN Prospect i ve r and omized study . METHODS Single-site recruitment of 458 patients using Veterans Health Administration care into a r and omized controlled trial with a 1-year preintervention data collection period and a 1-year intervention and follow-up period . To compensate for imbalanced study groups , propensity scores were included in adjusted models of quality of life , satisfaction with care , inpatient utilization , survival , and costs of care . RESULTS Patients aged 45 to 95 years participated in the study ; 22 % were of Hispanic race/ethnicity , and 7 % were African American . All but 5 were male , consistent with the older population among veterans . At baseline , 40 % were in Goldman Specific Activity Scale class I , 42 % were in class III , 6 % were in class II or IV , and 12 % were unclassified . Patients scored a mean ( SD ) of 14 ( 1.5 ) points below the norm on the physical component score . After the yearlong intervention , no differences in clinical outcomes were noted between the intervention group and the control group . The CHF-related costs were higher for the intervention group , as were overall costs that included the cost of the intervention . Intervention group patients reported better compliance with weight monitoring and exercise recommendations . CONCLUSIONS A risk-stratified intervention for patients with CHF result ed in potential behavioral improvements but no survival benefit . A high-cost high-intensity intervention may be required to improve survival for patients with CHF . Inclusion of the costs of interventions is recommended for future research ers
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 ) .