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 ) .
Randomised trial of telephone intervention in chronic heart failure: DIAL trial
Abstract Objective To determine whether a central ised telephone intervention reduces the incidence of death or admission for worsening heart failure in out patients with chronic heart failure . Design Multicentre r and omised controlled trial . Setting 51 centres in Argentina ( public and private hospitals and ambulatory setting s ) . Participants 1518 out patients with stable chronic heart failure and optimal drug treatment r and omised , stratified by attending cardiologist , to telephone intervention or usual care .  Intervention Education , counselling , and monitoring by nurses through frequent telephone follow-up in addition to usual care , delivered from a single centre . Main outcome measure All cause mortality or admission to hospital for worsening heart failure . Results Complete follow-up was available in 99.5 % of patients . The 758 patients in the usual care group were more likely to be admitted for worsening heart failure or to die ( 235 events , 31 % ) than the 760 patients who received the telephone intervention ( 200 events , 26.3 % ) ( relative risk reduction = 20 % , 95 % confidence interval 3 to 34 , P = 0.026 ) . This benefit was mostly due to a significant reduction in admissions for heart failure ( relative risk reduction = 29 % , P = 0.005 ) . Mortality was similar in both groups . At the end of the study the intervention group had a better quality of life than the usual care group ( mean total score on Minnesota living with heart failure question naire 30.6 v 35 , P = 0.001 ) . Conclusions This simple , central ised heart failure programme was effective in reducing the primary end point through a significant reduction in admissions to hospital for heart failure
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 ) .