Summary of study and patient characteristics
| Author, Year | Country (sites) | Population | Intervention | Comparator | Duration | Primary outcome |
|---|---|---|---|---|---|---|
| Structured telephone support: human to human contact versus telemonitoring versus usual care | ||||||
| Cleland et al 2005 (TEN-HMS)30 *† | Germany, Netherlands, UK (16 sites) | Patients (aged ≥18 years) with a recent admission for HF and LVEF <40%. | Structured (monthly) telephone-based monitoring (of symptoms and current medication) and education (n=173) | Standard care. Followed up by GP according to individualised patient management plan (n=85) | 240 days and 450 days | Composite of any hospital admission or mortality |
| Home telemonitoring. Twice daily measurement, automatic transmission of: weight, BP, HR and single lead ECG (n=168) | Standard care. Followed up by GP with according to individualised patient management plan (n=85) | 240 days and 450 days | Composite of any hospital admission or mortality | |||
| Structured telephone support : human to machine interface for example, telephone-based interactive response system versus usual care | ||||||
| Chaudhry et al, 2010 (Tele-HF)13 | USA (33 cardiology practices) | Patients recently hospitalised for HF | Structured (daily) telephone-based monitoring (of symptoms and weight) via a an interactive voice response system (n=826) | Standard optimal care. Followed by local physician. Guideline based therapy (n=827) | 6 months | Composite of readmission for any reason or death |
| Structured telephone support: human to human contact versus usual care | ||||||
| Angermann et al 2011 (INH)26 * | Germany (9 hospitals) | Patients (aged ≥18 years) hospitalised with signs and symptoms of decompensated (systolic) HF with evidence of pulmonary congestions on chest x-ray and LVEF ≤40% (echocardiography) | Structured (weekly during the 1st month, then individualised: fortnightly in NYHA III and IV, monthly in NYHA I and II) telephone-based monitoring (of symptoms and current medication) and modular education (n=352) | Standard care. Followed up by GP plus 6 monthly visits to a HF clinic (n=363) | 6 months | Composite of time to all-cause death or rehospitalisation |
| Barth 200128 *† | USA (1 hospital) | Patients discharged from acute care to home with primary diagnosis of HF | Structured (at 72 hours, 144 hours, and then fortnightly) telephone-based monitoring (of signs, symptoms and weight) and education. Nurse-managed (n=17) | Standard care (no details provided) (n=17) | 3 months | NR |
| DeBusk et al 200431*† | USA (5 hospitals) | Patients hospitalised with a provisional diagnosis of HF (based on clinical signs and symptoms or evidence of pulmonary congestions on chest radiograph) | Structured (weekly for 6 weeks, biweekly for 8 weeks and then monthly and bimonthly) telephone-based HF lifestyle education and medication management (n=228) | NR; however, standard care appeared to involve a high frequency of all of kinds of follow-up clinic visits (13 in 12 months following hospitalisation) (n=234) | 12 months | Composite of rehospitalisation for HF or all-cause rehospitalisation |
| Domingues et al 201124 | Brazil (1 tertiary hospital) | Hospitalised patients (aged ≥ 18 years) with HF (diagnosed using Boston diagnostic criteria) and LVEF ≤45% | Structured (weekly for 1st month, every 15 days for following 2 months) telephone-based education and monitoring signs and symptoms of decompensation. Nurse managed (n=57) | Standard care (no details provided) (n=63) | 3 months | Level of HF awareness and self-care knowledge |
| Laramee et al 200334*† | USA (1 hospital) | Patients admitted to hospital with primary or secondary diagnosis of HF (based on clinical signs and symptoms, left ventricular dysfunction <40% or radiological evidence of pulmonary oedema and symptomatic improvement following diuresis) | Structured (weekly for first 4 weeks, then biweekly) telephone-based monitoring (of signs and symptoms) and education. Nurse-managed (n=141) | Standard care. Followed up by local physician (44% received some home care services) (n=146) | 3 months | All-cause re-admission |
| Rainville 199935* | USA (1 site) | Patients (aged ≥50 years) discharged from hospital with HF. | Structured (at days 3, 7, 30 and 90, and 12 months) telephone-based education, medication review and management and weight monitoring. Pharmacist-led (n=19) | Standard care. Followed up by pharmacist at 30 days, 90 days and 12 months to determine readmissions (n=19) | 12 months | Composite of hospital readmission for HF or mortality |
| Riegel et al 200236*† | USA (2 hospitals) | Patients discharged from hospital with HF | Structured (at day 5 and thereafter at a frequency guided by the software and case manager) telephone-based education and monitoring of signs and symptoms (eg, weight, fluid retention, dyspnoea) (n=130) Nurse managed with guidance and liaison with primary care physician | Non standardised care (no details provided) (n=228) | 6 months | HF re-hospitalisations |
| Riegel et al 200637*† | USA (2 hospitals) | Hospitalised Hispanic patients with a primary or secondary diagnosis of HF, living in the community | Structured (at day 5 and thereafter at a frequency guided by the software and case manager) telephone-based education, monitoring of signs and symptoms indicating worsening illness (n=70) | Non-standardised care (no details provided) (n=65) | 6 months | HF rehospitalisations |
| Tsuyuki et al 2004 (REACT)38* | Canada (10 hospitals) | Patients (aged >18 years) discharged from hospital with HF | Structured (at 2 weeks, 4 weeks, then monthly for six months) telephone-based education and monitoring of signs and symptoms (including salt and fluid restriction and weight) (n=140) | Standardised care (no details provided) (n=136) | 6 months | Medication adherence |
| Wakefield et al 200839* | USA (1 hospital) | Patients hospitalised for HF exacerbation (eg, volume overload, pulmonary oedema) | Structured telephone or videophone- based education and monitoring of signs and symptoms (including weight, BP and ankle circumference) (n=99) | NR; however, subjects contacted their primary care nurse case manager by telephone if needed (n=49) | 12 months | Readmission rates |
| Telemonitoring versus usual care | ||||||
| Antonicelli et al 200827* | Italy (1 hospital) | Patients (aged ≥70 years) hospitalised for worsening symptoms and signs of HF (NYHA class II-IV), with evidence of pulmonary congestions on chest x-ray and ejection fraction on echocardiography | Home telemonitoring. Weekly measurement, manual transmission of: weight, BP, HR, 12-lead ECG, 24 h urine output (n=28) | Standard care. Followed by a HF specialist team (including routinely scheduled clinic visits) (n=29) | 12 months | Composite of mortality and hospitalisation |
| Capomolla et al 200429* | Italy (1 hospital) | Patients discharged from specialist HF unit to home | Home telemonitoring. Daily measurement, manual transmission (via touch pad of home or mobile phone to an interactive voice response system) of: weight, systolic BP, HR and symptoms (n=67) | Standard care. Followed up by GP with support of a cardiologist. During follow-up, the process of care was governed by different providers with a heterogeneous range of strategies: emergency room management, hospital admission and outpatient access (n=66) | 12 months | Composite of rehospitalisation, emergency room access and total mortality |
| Dar et al 2009 (Home-HF)22 | UK (3 acute hospitals) | Patients discharged after a hospitalisation with HF (defined by ESC criteria: either a new diagnosis or an acute decompensation of CHF) and NYHA class II-IV symptoms | Home telemonitoring. Daily measurement, manual transmission of: weight, BP, HR, oxygen saturation and symptoms. (n=91) | Standard care. Each site had a specialist HF service including at least one cardiologist or physician with an interest in HF, and at least one HF specialist nurse. Regular clinical follow-ups were scheduled at the discretion of the HF team, and telephone support was available during office hours (n=91) | 6 months | Days alive and outside of hospital |
| Dendale et al, 2011 (TEMA-HF1)23 | Belgium (7 hospitals) | Patients hospitalised for fluid overload due to HF requiring an increase or initiation of diuretic therapy (treated with ACE inhibitor or angiotensin II receptor antagonist with β-blocker, if tolerated) | Home telemonitoring. Daily measurement, automatic transmission of: weight, BP, HR (n=80) | Standard care. Followed up by GP (with referral to specialist cardiologist if needed). Guideline-based therapy. No intervention by study nurse or HF clinical team (n=80) | 6 months | All-cause mortality |
| Goldberg et al 2003 (WHARF)32*† | USA (16 sites) | Patients admitted to hospital with decompensated, advanced HF (NYHA Class III-IV), secondary to systolic dysfunction (LVEF <35%, measured within 6 months of enrolment) | Home telemonitoring. Daily measurement, manual transmission of: weight and symptoms (n=138) | Standard care. Followed up by treating physician (at discretion) in a dedicated outpatient HF programme with additional nursing resources. In addition, patients undertook daily weight measurements and were instructed to contact their physician for weight increases of more than a prespecified amount or if their symptoms of HF worsened (n=142) | 6 months (mean) | Hospital readmission |
| Kielblock et al 200733*† | Germany (sites NR) | Patients discharged after a hospitalisation with HF or with a confirmed diagnosis from ICD codes from hospital insurance data | Home telemonitoring. Daily measurement, automatic transmission of: weight (n=251) | Standard care (no details provided) (n=251) | 12 months | Hospital stay |
| Kulshreshta et al, 201015* | USA (1 hospital) | Hospitalised (current admission or recently discharged within prior 2 weeks) or high risk for readmission (cardiac related reasons or ejection fraction ≤20%), non-homebound patients (age >18 years) with HF | Home telemonitoring. Daily measurement, manual transmission of: weight, BP, pulse and pulse oximetry (n=68) | Standard care (no details provided) (n=42) | 6 months | All-cause rehospitalisation rate |
| Scherr et al, 2009 (MOBITEL)25 | Austria (8 centres) | Patients (aged 18–80 years) with acute worsening of HF (acute cardiac decompensation) with hospitalisation >24 hours in the last 4 weeks | Home telemonitoring. Daily measurement, manual transmission of: weight, BP, HR, and dosage of HF medication (n=66) | Standard care. Pharmacological treatment according to guideline-based therapy (n=54) | 6 months | Composite of cardiovascular mortality/hospital readmission for worsening HF |
| Woodend et al 200840*† | Canada (1 site) | Patients with symptomatic HF (NYHA Class II or greater). | Home telemonitoring. Daily measurement, manual transmission of: weight, BP and 12-lead ECG (periodic) (n=62) | Standard care. Followed up by community physician or cardiologist (no further details provided) (n=59) | 3 and 12 months | NR |
*Identified in review by Inglis et al.12
†Identified in review by Klersy et al.11
BP, blood pressure; CHF, chronic heart failure; ESC, European Society of Cardiology; EQ-5D, European Quality of Life 5-Dimensions; GP, general practitioner; HF, heart failure; HR, heart rate; ICD, International Classification of Diseases; INH, Interdisciplinary Network for Heart Failure; LVEF, left ventricular ejection fraction; NR, not reported; NYHA, New York Heart Association; SF-36, Short-Form Questionnaire-36 Items; TIM-HF, Telemedical Interventional Monitoring in Heart Failure; TEN-HMS, Trans-European Network Home-Care Management System.