Telemonitoring or structured telephone support programmes for patients with chronic heart failure: systematic review and meta-analysisBMJ 2007; 334 doi: https://doi.org/10.1136/bmj.39156.536968.55 (Published 03 May 2007) Cite this as: BMJ 2007;334:942
- Robyn A Clark, scholar1,
- Sally C Inglis, scholar2,
- Finlay A McAlister, associate professor3,
- John G F Cleland, professor4,
- Simon Stewart, professor5
- 1Division of Health Sciences, University of South Australia, Adelaide, Australia
- 2Faculty of Health Sciences, University of Queensland, Brisbane, Australia
- 3Division of General Internal Medicine, University of Alberta, Edmonton, Canada
- 4Academic Cardiology, University of Hull, Hull
- 5Preventative Cardiology Unit, Baker Heart Research Institute, Prahran, Melbourne, Vic 3004, Australia
- Correspondence to: S Stewart email@example.com
- Accepted 19 February 2007
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.
We thank librarian Margaret Goedhart (University of South Australia) for her knowledge and skill in navigating bibliographies and electronic sources, and the following investigators for further data and information from their studies: WA Gattis, LR Goldberg, A Laramee, B Riegel, RT Tsuyuki, A Woodend, and S Scalvini.
Contributors: RAC conceived and designed the study. RAC and SCI reviewed the literature, developed the study protocol, and searched for and abstracted the data. RAC, SCI, SS, and JGFC analysed and interpreted the data. FAMcA assessed the quality of extracted data and was responsible for synthesis and analysis of the data. He will act as guarantor. JGFC hand searched the literature and referred experts to RAC and SCI. All authors contributed to the drafting of the article and revising it for important intellectual content.
Funding: RAC is supported by the National Institute of Clinical Studies and the National Heart Foundation of Australia. SCI and SS are supported by the National Health and Medical Research Council and the National Heart Foundation of Australia. FAMcA receives salary support from the Alberta Heritage Foundation for medical research population health scholar programme, the Canadian Institutes of Health Research new investigator programme, and the University of Alberta/Merck Frost/Aventis chair in patient health management. JGFC (within the past five years) was principal investigator transEuropean network homecare management system study and received research funds from the European Union and Phillips Healthcare to carry out the study and has received honorariums from Phillips for speaking on telemonitoring. JGFC is a consultant to the EU sponsored MyHeart project which is part funded by Phillips and other manufacturers of telehealth devices.
Ethical approval: Not required.
- Accepted 19 February 2007