Home telemonitoring or structured telephone support programmes after recent discharge in patients with heart failure: systematic review and economic evaluation

• Published in: Health technology assessment (Winchester, England) England), 2013-08, Vol.17 (32), p.1-207
• Main Authors: Pandor, A, Thokala, P, Gomersall, T, Baalbaki, H, Stevens, J W, Wang, J, Wong, R, Brennan, A, Fitzgerald, P
• Format: Article
• Language: English
• Subjects: Cost-Benefit Analysis; heart failure; Heart Failure - diagnosis; Heart Failure - economics; Heart Failure - therapy; Home Care Services - economics; Home Care Services - organization & administration; home telemonitoring; Humans; Markov Chains; Monitoring, Physiologic - economics; Monitoring, Physiologic - methods; Patient Discharge; Patient Readmission; remote monitoring; structured telephone support; systematic review; Telemedicine - economics; Telemedicine - methods; Telephone
• ISSN: 1366-5278; 2046-4924
• DOI: 10.3310/hta17320

Remote monitoring (RM) strategies have the potential to deliver specialised care and management to patients with heart failure (HF). 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. Fourteen electronic databases (including MEDLINE, EMBASE, PsycINFO and The Cochrane Library) and research registers were searched to January 2012, supplemented by hand-searching relevant articles and contact with experts. The review included randomised 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). A systematic review and network meta-analysis (where appropriate) of the clinical evidence was carried out using standard methods. A Markov model was developed to evaluate the cost-effectiveness of different RM packages compared with usual care for recently discharged HF patients. TM 24/7 or using cardiovascular monitoring devices was not considered in the economic model because of the lack of data and/or unsuitability for the UK setting. Given the heterogeneity in the components of usual care and RM interventions, the cost-effectiveness analysis was performed using a set of costing scenarios designed to reflect the different configurations of usual care and RM in the UK. The literature searches identified 3060 citations. Six RCTs met the inclusion criteria and were added to the 15 trials identified from the previous systematic reviews giving a total of 21 RCTs included in the systematic review. No trials of cardiovascular implanted monitoring devices or observational studies met the inclusion criteria. The methodological quality of the studies varied widely and reporting was generally poor. Compared with usual care, RM was beneficial in reducing all-cause mortality for STS HH [hazard ratio (HR) 0.77, 95% credible interval (CrI) 0.55 to 1.08], TM during office hours (HR 0.76, 95% CrI 0.49 to 1.18) and TM 24/7 (HR 0.49, 95% CrI 0.20 to 1.18); however, these results were statistically inconclusive. The results for TM 24/7 should be treated with cau