title: Telemonitoring in patients with heart failure.
abstract: BACKGROUND
  Small studies suggest that telemonitoring may improve heart-failure outcomes, but its effect in a large trial has not been established.
  
  
  METHODS
  We randomly assigned 1653 patients who had recently been hospitalized for heart failure to undergo either telemonitoring (826 patients) or usual care (827 patients). Telemonitoring was accomplished by means of a telephone-based interactive voice-response system that collected daily information about symptoms and weight that was reviewed by the patients' clinicians. The primary end point was readmission for any reason or death from any cause within 180 days after enrollment. Secondary end points included hospitalization for heart failure, number of days in the hospital, and number of hospitalizations.
  
  
  RESULTS
  The median age of the patients was 61 years; 42.0% were female, and 39.0% were black. The telemonitoring group and the usual-care group did not differ significantly with respect to the primary end point, which occurred in 52.3% and 51.5% of patients, respectively (difference, 0.8 percentage points; 95% confidence interval [CI], -4.0 to 5.6; P=0.75 by the chi-square test). Readmission for any reason occurred in 49.3% of patients in the telemonitoring group and 47.4% of patients in the usual-care group (difference, 1.9 percentage points; 95% CI, -3.0 to 6.7; P=0.45 by the chi-square test). Death occurred in 11.1% of the telemonitoring group and 11.4% of the usual care group (difference, -0.2 percentage points; 95% CI, -3.3 to 2.8; P=0.88 by the chi-square test). There were no significant differences between the two groups with respect to the secondary end points or the time to the primary end point or its components. No adverse events were reported.
  
  
  CONCLUSIONS
  Among patients recently hospitalized for heart failure, telemonitoring did not improve outcomes. The results indicate the importance of a thorough, independent evaluation of disease-management strategies before their adoption. (Funded by the National Heart, Lung, and Blood Institute; ClinicalTrials.gov number, NCT00303212.).
authors.affiliation: Section of General Medicine, Department of Medicine, Yale University School of Medicine, New Haven, CT 06510, USA.
authors.forename: Sarwat I
authors.initials: SI
authors.lastname: Chaudhry
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Mattera
authors.forename: Jeptha P
authors.initials: JP
authors.lastname: Curtis
authors.forename: John A
authors.initials: JA
authors.lastname: Spertus
authors.forename: Jeph
authors.initials: J
authors.lastname: Herrin
authors.forename: Zhenqiu
authors.initials: Z
authors.lastname: Lin
authors.forename: Christopher O
authors.initials: CO
authors.lastname: Phillips
authors.forename: Beth V
authors.initials: BV
authors.lastname: Hodshon
authors.forename: Lawton S
authors.initials: LS
authors.lastname: Cooper
authors.forename: Harlan M
authors.initials: HM
authors.lastname: Krumholz
mesh_terms: D000368:Aged; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000628:therapy*; D006699:Home Care Services; D006760:Hospitalization; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods*; D010359:Patient Readmission / Q000706:statistics & numerical data; D012720:Severity of Illness Index; D017216:Telemedicine