title: Structured telephone support or telemonitoring programmes for patients with chronic heart failure.
abstract: 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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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 Unpublished abstract data was included in sensitivity analyses.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.
  
  
  METHODS
  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.
  
  
  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.
  
  
  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.
authors.affiliation: Preventative Health, Baker IDI Heart and Diabetes Institute, Melbourne, Australia.
authors.forename: Sally C
authors.initials: SC
authors.lastname: Inglis
authors.forename: Robyn A
authors.initials: RA
authors.lastname: Clark
authors.forename: Finlay A
authors.initials: FA
authors.lastname: McAlister
authors.forename: Jocasta
authors.initials: J
authors.lastname: Ball
authors.forename: Christian
authors.initials: C
authors.lastname: Lewinter
authors.forename: Damien
authors.initials: D
authors.lastname: Cullington
authors.forename: Simon
authors.initials: S
authors.lastname: Stewart
authors.forename: John Gf
authors.initials: JG
authors.lastname: Cleland
mesh_terms: D000368:Aged; D002908:Chronic Disease; D006333:Heart Failure / Q000401:mortality / Q000628:therapy*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D013686:Telemetry / Q000379:methods*; D013689:Telephone