Telemonitoring or structured telephone support programmes for patients with chronic heart failure: systematic review and meta-analysis

• Published in: BMJ 2007-05, Vol.334 (7600), p.942-945
• Main Authors: Clark, Robyn A, Inglis, Sally C, McAlister, Finlay A, Cleland, John G F, Stewart, Simon
• Format: Article
• Language: English
• Subjects: Beta blockers; Biological and medical sciences; Cardiology. Vascular system; Chronic Disease; Chronic illnesses; Clinical outcomes; Clinical trials; Disease management; Experimentation; General aspects; Health care costs; Health outcomes; Heart; Heart failure; Heart Failure - mortality; Heart Failure - therapy; Heart failure, cardiogenic pulmonary edema, cardiac enlargement; Hospital admissions; Hospitalization - statistics & numerical data; Humans; Medical research; Medical sciences; Meta-analysis; Monitoring systems; Mortality; Prevention and actions; Psychoeducational intervention; Public health. Hygiene; Public health. Hygiene-occupational medicine; Quality of life; Randomized Controlled Trials as Topic; Remote Consultation - methods; Remote Consultation - standards; Structured interviews; Studies; Symptoms; Telemedicine; Telephone; Telephone services; Telephones; Treatment Outcome
• ISSN: 0959-8138; 0959-8146; 0959-535X; 1468-5833; 1756-1833
• DOI: 10.1136/bmj.39156.536968.55

Objective To determine whether remote monitoring (structured telephone support or telemonitoring) without regular clinic or home visits improves outcomes for patients with chronic heart failure.Data sources 15 electronic databases, hand searches of previous studies, and contact with authors and experts.Data extraction Two investigators independently screened the results.Review methods Published randomised controlled trials comparing remote monitoring programmes with usual care in patients with chronic heart failure managed within the community. Results 14 randomised controlled trials (4264 patients) of remote monitoring met the inclusion criteria: four evaluated telemonitoring, nine evaluated structured telephone support, and one evaluated both. Remote monitoring programmes reduced the rates of admission to hospital for chronic heart failure by 21% (95% confidence interval 11% to 31%) and all cause mortality by 20% (8% to 31%); of the six trials evaluating health related quality of life three reported significant benefits with remote monitoring, and of the four studies examining healthcare costs with structured telephone support three reported reduced cost and one no effect.Conclusion Programmes for chronic heart failure that include remote monitoring have a positive effect on clinical outcomes in community dwelling patients with chronic heart failure.