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Structured telephone support or non-invasive telemonitoring for patients with heart failure
  1. Sally C Inglis1,
  2. Robyn A Clark2,
  3. Riet Dierckx3,
  4. David Prieto-Merino4,5,
  5. John G F Cleland6
  1. 1Faculty of Health, University of Technology Sydney, Sydney, Australia
  2. 2School of Nursing and Midwifery, The Flinders University of South Australia, Adelaide, Australia
  3. 3Cardiovascular Center, OLV Hospital, Aalst, Belgium
  4. 4Applied Statistical Methods Research Group, Universidad Catolica de Murcia, Murcia, Spain
  5. 5Department of Non-communicable Disease, Epidemiology, London School of Hygiene & Tropical, Medicine, London, UK
  6. 6National Heart and Lung Institute, Imperial College London, London, UK
  1. Correspondence to Associate Professor Sally C Inglis, Faculty of Health, University of Technology Sydney, Sydney, NSW, 2007, Australia; sally.inglis{at}

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Heart failure is a common and growing problem, worldwide, often leading to repeated hospitalisations, reduced quality of life, disability, loss of independence and shortened life expectancy. Managing heart failure is costly and complex for individual patients, their families and healthcare systems. A range of pharmacological agents, devices and disease management programmes have proven to be effective but are not available to all patients. Non-invasive telemonitoring and structured telephone support for patients with heart failure have been researched for almost two decades; however the jury still appears to be out for the use of this intervention in clinical practice.1

The effectiveness of structured telephone support and non-invasive telemonitoring to reduce hospitalisations and mortality in patients with heart failure was assessed by a recent Cochrane review.2 This review was undertaken as an update to a previously published version. Randomised controlled trials (RCTs) that compared structured telephone support or non-invasive telemonitoring to standard practice were included. Studies were excluded if the telemonitoring intervention included other interventions such as home visits or frequent clinic visits or implanted monitoring devices. Compared with the previously published Cochrane review, 17 new studies were identified and 24 had been included in the previous review (total of 41 studies). Two studies were multiarm and included both structured telephone support and telemonitoring; hence there were 43 comparisons in the review. The primary outcomes included all-cause mortality and all-cause and heart failure related hospitalisations which were analysed using fixed-effects models.

The review demonstrated that both non-invasive telemonitoring and structured telephone support offer statistically and clinically meaningful benefits to people with heart failure.2 For non-invasive telemonitoring, a 20% reduction in the risk of all-cause mortality was observed (Relative Risk (RR) 0.80, 95% Confidence Interval (CI) 0.68 to 0.94; participants=3740; studies=17; I2=24%; Grading of Recommendations Assessment, Development and …

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