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Editorial
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}uts.edu.au

https://doi.org/10.1136/heartjnl-2015-309191

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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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    Footnotes

    • Twitter Follow Robyn A Clark at @clark_ra

    • Contributors SCI: responsible for conception and design of this study and the previous versions of this review (Clark 2007a; Inglis 2010). Responsible for coordinating and completing the review. Responsible for all data included in the review including designing, undertaking searches, retrieving search results, screening studies for inclusion, assessing risk of bias of studies, extracting data from papers, contacting study authors for information, entering data into Review Manager 5, analysis and interpretation of data, drafting of the review or revising it critically for important intellectual content and final approval of the version to be published. Performed previous work that was the foundation of this study. RAC: responsible for conception and design of this study and the previous version of this review (Clark 2007a; Inglis 2010). Responsible for conceiving the initial idea for Clark 2007a. Responsible for all data included in the review including designing, undertaking searches, screening studies for inclusion, assessing risk of bias of studies, extracting data from papers, entering data into Review Manager 5, analysis and interpretation of data, drafting of the review or revising it critically for important intellectual content and final approval of the version to be published. Performed previous work that was the foundation of this study. RD: responsible for all data included in the review including undertaking handsearching of conference abstracts, retrieving search results, screening studies for inclusion, assessing risk of bias of studies, extracting data from papers, entering data into Review Manager 5, interpretation of data, drafting of the review or revising it critically for important intellectual content and final approval of the version to be published. DP-M: responsible for undertaking the heterogeneity tests between predefined subgroups and the meta-regression, review of statistical analyses undertaken in the review and drafting of sections of the review relevant to the heterogeneity analysis and meta-regression findings and approval of the version to be published. JGFC: consulted on design of review. Responsible for adjudicating study inclusion, interpretation of data (providing a methodological and clinical view), revising the review critically for important intellectual content and final approval of the version to be published. Guarantor for this review.

    • Funding RAC is supported by a Heart Foundation Future Leader Fellowship (APP100847 2016-2019). SCI, Cardiovascular Life Sciences Fellow, New South Wales Cardiovascular Research Network, supported by the Heart Foundation of Australia and the NSW Office for Health and Medical Research (CR 11S 6226). JGFC, Senior Investigator, National Institute of Health Research (UK) for grant funding. This review was supported by funding from the NHS NIHR Cochrane Incentive Scheme, UK and the University of Technology Sydney, Australia. For details of funding support for previous published versions of this review, please refer to the Cochrane Review published in the Cochrane Database of Systematic Reviews.

    • Competing interests None declared.

    • Provenance and peer review Commissioned; internally peer reviewed.