title: Is age a factor in the success or failure of remote monitoring in heart failure? Telemonitoring and structured telephone support in elderly heart failure patients.
abstract: BACKGROUND
  There are few data regarding the effectiveness of remote monitoring for older people with heart failure. We conducted a post-hoc sub-analysis of a previously published large Cochrane systematic review and meta-analysis of relevant randomized controlled trials to determine whether structured telephone support and telemonitoring were effective in this population.
  
  
  METHODS
  A post hoc sub-analysis of a systematic review and meta-analysis that applied the Cochrane methodology was conducted. Meta-analyses of all-cause mortality, all-cause hospitalizations and heart failure-related hospitalizations were performed for studies where the mean or median age of participants was 70 or more years.
  
  
  RESULTS
  The mean or median age of participants was 70 or more years in eight of the 16 (n=2659/5613; 47%) structured telephone support studies and four of the 11 (n=894/2710; 33%) telemonitoring studies. Structured telephone support (RR 0.80; 95% CI=0.63-1.00) and telemonitoring (RR 0.56; 95% CI=0.41-0.76) interventions reduced mortality. Structured telephone support interventions reduced heart failure-related hospitalizations (RR 0.81; 95% CI=0.67-0.99).
  
  
  CONCLUSIONS
  Despite a systematic bias towards recruitment of individuals younger than the epidemiological average into the randomized controlled trials, older people with heart failure did benefit from structured telephone support and telemonitoring. These post-hoc sub-analysis results were similar to overall effects observed in the main meta-analysis. While further research is required to confirm these observational findings, the evidence at hand indicates that discrimination by age alone may be not be appropriate when inviting participation in a remote monitoring service for heart failure.
authors.affiliation: University of Technology, Sydney, Australia.
authors.forename: Sally C
authors.initials: SC
authors.lastname: Inglis
authors.affiliation: Queensland University Technology, Australia.
authors.forename: Aaron
authors.initials: A
authors.lastname: Conway
authors.affiliation: Castle Hill Hospital, UK.
authors.forename: John Gf
authors.initials: JG
authors.lastname: Cleland
authors.affiliation: Flinders University, Australia robyn.clark@flinders.edu.au.
authors.forename: Robyn A
authors.initials: RA
authors.lastname: Clark
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D015577:Geriatric Assessment; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D006801:Humans; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods; D010349:Patient Compliance / Q000706:statistics & numerical data*; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D015996:Survival Rate; D017216:Telemedicine / Q000379:methods*; D013686:Telemetry / Q000379:methods*; D013689:Telephone / Q000706:statistics & numerical data; D016896:Treatment Outcome
keywords: Heart failure; ageing; elderly; geriatric; remote monitoring; systematic review