Structured telephone support or telemonitoring programmes for patients with chronic heart failure
Open accessAbstract
BACKGROUND: Specialised disease management programmes for chronic heart failure (CHF) improve survival, quality of life and reduce healthcare utilisation. The overall efficacy of structured telephone support or telemonitoring as an individual component of a CHF disease management strategy remains inconclusive. OBJECTIVES: To review randomised controlled trials (RCTs) of structured telephone support or telemonitoring compared to standard practice for patients with CHF in order to quantify the effects of these interventions over and above usual care for these patients. SEARCH STRATEGY: Databases (the Cochrane Central Register of Controlled Trials (CENTRAL), Database of Abstracts of Reviews of Effects (DARE) and Health Technology Assessment Database (HTA) on The Cochrane Library, MEDLINE, EMBASE, CINAHL, AMED and Science Citation Index Expanded and Conference Citation Index on ISI Web of Knowledge) and various search engines were searched from 2006 to November 2008 to update a previously published non-Cochrane review. Bibliographies of relevant studies and systematic reviews and abstract conference proceedings were handsearched. No language limits were applied. SELECTION CRITERIA: Only peer reviewed, published RCTs comparing structured telephone support or telemonitoring to usual care of CHF patients were included. Unpublished abstract data was included in sensitivity analyses. The intervention or usual care could not include a home visit or more than the usual (four to six weeks) clinic follow-up. DATA COLLECTION AND ANALYSIS: Data were presented as risk ratio (RR) with 95% confidence intervals (CI). Primary outcomes included all-cause mortality, all-cause and CHF-related hospitalisations which were meta-analysed using fixed effects models. Other outcomes included length of stay, quality of life, acceptability and cost and these were described and tabulated. MAIN RESULTS: Twenty-five studies and five published abstracts were included. Of the 25 full peer-reviewed studies meta-analysed, 16 evaluated structured telephone support (5613 participants), 11 evaluated telemonitoring (2710 participants), and two tested both interventions (included in counts). Telemonitoring reduced all-cause mortality (RR 0.66, 95% CI 0.54 to 0.81, P < 0.0001) with structured telephone support demonstrating a non-significant positive effect (RR 0.88, 95% CI 0.76 to 1.01, P = 0.08). Both structured telephone support (RR 0.77, 95% CI 0.68 to 0.87, P < 0.0001) and telemonitoring (RR 0.79, 95% CI 0.67 to 0.94, P = 0.008) reduced CHF-related hospitalisations. For both interventions, several studies improved quality of life, reduced healthcare costs and were acceptable to patients. Improvements in prescribing, patient knowledge and self-care, and New York Heart Association (NYHA) functional class were observed. AUTHORS' CONCLUSIONS: Structured telephone support and telemonitoring are effective in reducing the risk of all-cause mortality and CHF-related hospitalisations in patients with CHF; they improve quality of life, reduce costs, and evidence-based prescribing.
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The Cochrane review of chronic heart failure reported a small significant reduction in all-cause hospitalisations for structured telephone support compared with usual care (relative risk 0.9, 95% CI 0.9 to 1.0) and for telemonitoring compared with usual care (relative risk 0.9, 95% CI 0.8 to 1.0).
“the Cochrane review of chronic heart failure reported a small significant reduction in all-cause hospitalisations for both structured telephone support compared with usual care (relative risk 0.9 (95% CI 0.9 to 1.0) and for telemonitoring compared with usual care (relative risk 0.9 (95% C.I. 0.8 to 1.0) [46].”
From The Impact of Telehealthcare on the Quality and Safety of Care: A Systematic Overview (2013) · cites this paper as [46]
In the same Cochrane review, telemonitoring resulted in a significant relative risk of 0.66 (95% CI 0.54 to 0.81) for all-cause mortality.
“and telemonitoring resulted in a significant relative risk of 0.66 (95% CI 0.54 to 0.81).”
From The Impact of Telehealthcare on the Quality and Safety of Care: A Systematic Overview (2013) · cites this paper as [46]
In a Cochrane review, pooling all-cause mortality data from 15 studies, structured telephone support resulted in a non-significant relative risk of 0.88 (95% CI 0.76 to 1.01).
“In the pooling of all-cause mortality data from 15 studies structured telephone support resulted in a non-significant relative risk of 0.88 (95% C.I. 0.76 to 1.01) [46]”
From The Impact of Telehealthcare on the Quality and Safety of Care: A Systematic Overview (2013) · cites this paper as [46]
In terms of chronic heart failure related hospitalisations, both structured telephone support (relative risk 0.8, 95% CI 0.7 to 0.9) and telemonitoring (relative risk 0.8, 95% CI 0.7 to 0.9) demonstrated significant reductions.
“In terms of chronic heart failure related hospitalisations, again both structured telephone support (relative risk 0.8, 95% C.I. 0.7 to 0.9) and telemonitoring (relative risk 0.8, 95% C.I. 0.7 to 0.9) demonstrated significant reductions [46].”
From The Impact of Telehealthcare on the Quality and Safety of Care: A Systematic Overview (2013) · cites this paper as [46]
The Cochrane review of heart failure reported that quality of life was a secondary outcome for 15 studies, with nine studies reporting improvement in quality of life.
“The Cochrane review of heart failure reported that quality of life was a secondary outcome for 15 studies altogether, with nine studies reporting improvement in quality of life [46].”
From The Impact of Telehealthcare on the Quality and Safety of Care: A Systematic Overview (2013) · cites this paper as [46]
Most reviews (8/15, 53%) did not provide sufficient details about the technology used in each of the included primary studies.
“most reviews (8/15, 53%) did not provide sufficient details about the technology used in each of the included primary studies [33,34,36-40,45-47]”
From Effects of Home Telemonitoring Interventions on Patients With Chronic Heart Failure: An Overview of Systematic Reviews (2015) · cites this paper as [34]
Usual care varied across studies from in-person follow-up visits to a general practitioner or primary care provider to attendance at an outpatient clinic-based disease management program.
“Usual care varied across studies from in-person follow-up visits to a general practitioner or primary care provider to attendance at an outpatient clinic-based disease management program [33,34,36,37,47,49].”
From Effects of Home Telemonitoring Interventions on Patients With Chronic Heart Failure: An Overview of Systematic Reviews (2015) · cites this paper as [34]
Six reviews reported that most participants in the included studies were NYHA class II-IV.
“Six reviews reported that most participants in the included studies were NYHA class II-IV [34-35,37-39,47].”
From Effects of Home Telemonitoring Interventions on Patients With Chronic Heart Failure: An Overview of Systematic Reviews (2015) · cites this paper as [34]
The majority of systematic reviews (10/15, 67%) summarized and reported relevant information about the type of physiological measures monitored in the included trials.
“While the majority of systematic reviews (10/15, 67%) summarized and reported relevant information about the type of physiological measures monitored in the included trials [33,34,37,38,41-44,47,49]”
From Effects of Home Telemonitoring Interventions on Patients With Chronic Heart Failure: An Overview of Systematic Reviews (2015) · cites this paper as [34]
In stable and recently discharged patients, home telemonitoring with clinical support provided during office hours or 24/7, without home visits for clinical assessment or educational purposes, compared with usual care reduces HF-related hospitalizations (RR 0.79, 95% CI 0.67 to 0.94; 60 fewer per 1000, from 17 fewer to 94 fewer) over 8-12 months.
“| | Population: Stable and recently discharged patients | 1570 (4 studies) 8-12 months | MODERATE due to risk of biase | RR 0.79 (0.67 to 0.94) | 285 per 1000 | 60 fewer per 1000 (from 17 fewer to 94 fewer) |”
From Effects of Home Telemonitoring Interventions on Patients With Chronic Heart Failure: An Overview of Systematic Reviews (2015) · cites this paper as [34]
In the pooling of all-cause mortality data from 11 RCTs involving 2710 patients with HF, HT resulted in statistically significant risk reduction of 34% (RR 0.66 [95% CI 0.54-0.81]); an ARR of 5.2% (95% CI -2.9 to -7.1), equating to a number needed to treat of 19 to postpone one death.
“In the pooling of all-cause mortality data from 11 RCTs involving 2710 patients with HF, HT resulted in statistically significant risk reduction of 34% (RR 0.66 [95% CI 0.54-0.81]); an ARR of 5.2% (95% CI -2.9 to -7.1), equating to a number needed to treat of 19 to postpone one death.”
From Effects of Home Telemonitoring Interventions on Patients With Chronic Heart Failure: An Overview of Systematic Reviews (2015) · cites this paper as [34]
In stable and recently discharged patients, home telemonitoring with clinical support provided during office hours or 24/7, without home visits for clinical assessment or educational purposes, compared with usual care reduces all-cause hospitalization (RR 0.91, 95% CI 0.84 to 0.99; 47 fewer per 1000, from 5 fewer to 83 fewer) over 6-12 months.
“| | Population: Stable and recently discharged patients | 2343 (8 studies) 6-12 months | LOW due to risk of bias, inconsistency, and imprecisione-g | RR 0.91 (0.84 to 0.99) | 521 per 1000 | 47 fewer per 1000 (from 5 fewer to 83 fewer) |”
From Effects of Home Telemonitoring Interventions on Patients With Chronic Heart Failure: An Overview of Systematic Reviews (2015) · cites this paper as [34]
The strongest evidence (moderate quality) comes from a high-quality meta-analysis of 4 large RCTs (N=1570 patients), which found statistically significant risk reductions of 21% in HF-related hospitalizations with HT versus usual care, equating to an ARR of 6% (95% CI-1.7 to -9.7).
“As shown in Table 9, the strongest evidence (moderate quality) comes from a high-quality meta-analysis of 4 large RCTs (N=1570 patients), which found statistically significant risk reductions of 21% in HF-related hospitalizations with HT versus usual care, equating to an ARR of 6% (95% CI-1.7 to -9.7) [34].”
From Effects of Home Telemonitoring Interventions on Patients With Chronic Heart Failure: An Overview of Systematic Reviews (2015) · cites this paper as [34]
Of them, five pooled study results into a meta-analysis.
“Of them, five pooled study results into a meta-analysis [33-37].”
From Effects of Home Telemonitoring Interventions on Patients With Chronic Heart Failure: An Overview of Systematic Reviews (2015) · cites this paper as [34]
Eight reviews concurred that the impact of HT interventions on health care costs appeared to be positive in more cases than not, but in general results were statistically inconclusive and varied depending on the context and specific national health system of the study.
“Eight reviews concurred that the impact of HT interventions on health care costs appeared to be positive in more cases than not, but in general results were statistically inconclusive and varied depending on the context and specific national health system of the study [34,36,38,39,41,43,44,47].”
From Effects of Home Telemonitoring Interventions on Patients With Chronic Heart Failure: An Overview of Systematic Reviews (2015) · cites this paper as [34]
Three reviews, all of which focused on RCTs, concluded that the impact of HT on length of stay was ambivalent.
“Three reviews, all of which focused on RCTs, concluded that the impact of HT on length of stay was ambivalent [34,36,37].”
From Effects of Home Telemonitoring Interventions on Patients With Chronic Heart Failure: An Overview of Systematic Reviews (2015) · cites this paper as [34]
The bulk of the literature consists of low-quality and inconsistent evidence about the beneficial effects of HT on all-cause hospitalizations.
“Yet the bulk of the literature consists of low-quality and inconsistent evidence about the beneficial effects of HT on all-cause hospitalizations [34,37].”
From Effects of Home Telemonitoring Interventions on Patients With Chronic Heart Failure: An Overview of Systematic Reviews (2015) · cites this paper as [34]
In most reviews, data extraction and reporting pertaining to quality of life was inadequate, since authors focused on the statistical significance of study results rather than the direction and magnitude of effect.
“In most reviews, data extraction and reporting pertaining to this outcome was inadequate, since authors focused on the statistical significance of study results rather than the direction and magnitude of effect [33-35,39,44].”
From Effects of Home Telemonitoring Interventions on Patients With Chronic Heart Failure: An Overview of Systematic Reviews (2015) · cites this paper as [34]
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Flagged first, then by citations
6 of the 331 references couldn’t be matched to a known paper.
Research works printed but not linked: 2
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- Authors
- Inglis, S. C., Clark, R. A., McAlister, F. A., Ball, J., Lewinter, C., Cullington, D., Stewart, S., & Cleland, J. G.
- Affiliations
- Baker Heart and Diabetes Institute (AU)
- Queensland University of Technology (AU)
- University of Alberta (CA)
- Castle Hill Hospital (GB)
- ORCID
- Venue
- Cochrane Database of Systematic Reviews
- Publisher
- John Wiley & Sons, Ltd
- Published
- 2010-08-04
- Issue
- 8
- Pages
- CD007228-CD007228
- ISSN
- 1361-6137 (ISSN-L)
- OpenAlex
- W2097377402
- Cited by
- 614
- References
- 331
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 17 · 2023: 11 · 2022: 27 · 2021: 29 · 2020: 28 · 2019: 22 · 2018: 30 · 2017: 36 · 2016: 39 · 2015: 64 · 2014: 72 · 2013: 76 · 2012: 70
- Type
- reference entry
- Language
- en
- Update notices
- new_version (2015-10-31)
- Open access
- bronze
- doi.org
- Locations
- Cochrane Database of Systematic Reviews (publishedVersion)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- UTS ePRESS (University of Technology Sydney) (submittedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Keywords
- chronic heart failure, telephone support, remote patient monitoring, disease management programs, all-cause mortality, hospitalization, length of hospital stay, quality of life, health care utilization, cost-effectiveness, acceptability, usual care comparison, telehealth intervention, patient-centered care
- MeSH terms
- Aged, Chronic Disease, Heart Failure, Hospitalization, Humans, Quality of Life, Telemetry, Telephone, Randomized Controlled Trials as Topic
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