Which components of heart failure programmes are effective? A systematic review and meta-analysis of the outcomes of structured telephone support or telemonitoring as the primary component of chronic heart failure management in 8323 patients: Abridged Cochrane Review

Publication Type:
Journal Article
Citation:
European Journal of Heart Failure, 2011, 13 (9), pp. 1028 - 1040
Issue Date:
2011-09-01
Full metadata record
Files in This Item:
Filename Description Size
Thumbnail2010005780OK.pdf1.18 MB
Adobe PDF
Aims Telemonitoring (TM) and structured telephone support (STS) have the potential to deliver specialized management to more patients with chronic heart failure (CHF), but their efficacy is still to be proven. The aim of this meta-analysis was to review randomized controlled trials (RCTs) of TM or STS for all-cause mortality and all-cause and CHF-related hospitalizations in patients with CHF, as a non-invasive remote model of a specialized disease-management intervention. Methods and resultsWe searched all relevant electronic databases and search engines, hand-searched bibliographies of relevant studies, systematic reviews, and meeting abstracts. Two reviewers independently extracted all data. Randomized controlled trials comparing TM or STS to usual care in patients with CHF were included. Studies that included intensified management with additional home or clinic-visits were excluded. Primary outcomes (mortality and hospitalizations) were analysed; secondary outcomes (cost, length of stay, and quality of life) were tabulated. Thirty RCTs of STS and TM were identified (25 peer-reviewed publications (n 8323) and five abstracts (n 1482)). Of the 25 peer-reviewed studies, 11 evaluated TM (2710 participants), 16 evaluated STS (5613 participants) with two testing both STS and TM in separate intervention arms compared with usual care. Telemonitoring reduced all-cause mortality risk ratio (RR) 0.66 [95 confidence interval (CI) 0.540.81], P< 0.0001 and STS showed a similar, but non-significant trend [RR 0.88 (95 CI 0.761.01), P 0.08]. Both TM [RR 0.79 (95 CI 0.670.94), P 0.008], and STS [RR 0.77 (95 CI 0.680.87), P< 0.0001] reduced CHF-related hospitalizations. Both interventions improved quality of life, reduced costs, and were acceptable to patients. Improvements in prescribing, patient-knowledge and self-care, and functional class were observed. ConclusionTelemonitoring and STS both appear effective interventions to improve outcomes in patients with CHF. © 2011 The Author.
Please use this identifier to cite or link to this item: