Implementation of structured telephone support and non-invasive home telemonitoring should be considered an evidence-based strategy to improve the quality of care and outcomes for people with heart failure
In the context of limited health funding and a rapidly expanding population of older people, it is increasingly difficult for healthcare systems to provide high-quality care to those with heart failure. Multidisciplinary specialist heart failure clinics are available only to a minority of people and do not have the capacity for frequent patient review. Patients may be unwilling or unable to make frequent clinic attendance due to cost, difficulty with transport, or disability and frailty.
Structured telephone support and telemonitoring can provide specialized heart failure care to a large number of people with limited access to healthcare services. Structured telephone support may include self-monitoring and education delivered via standard telephone. Telemonitoring often includes more advanced technology such as the electronic transfer and remote monitoring of electrocardiograph, blood pressure, weight, pulse oximetry, respiratory rate, and medicine administration.
A team of Cochrane authors based in Australia, Belgium, and the United Kingdom worked with Cochrane Heart to determine the effectiveness of structured telephone support or non-invasive home telemonitoring compared to standard practice for people with heart failure. The researchers included 41 studies in this review; 25 evaluated structured telephone support (9332 participants), and 18 evaluated telemonitoring (3860 participants). Two of the included studies trialled both structured telephone support and telemonitoring compared to usual care, therefore 43 comparisons are evident.
This review demonstrates that supporting people with heart failure at home using information technology can reduce the rates of death and heart failure-related hospitalization. It can improve people's quality of life and knowledge about heart failure and self-care. Most patients, even those who are elderly, learn to use the technology easily and are satisfied with these interventions.
“For patients with heart failure, implementation of structured telephone support and non-invasive home telemonitoring should be considered an evidence-based strategy to improve the quality of care and outcomes for people with heart failure,” said Sally Inglis, from the Centre for Cardiovascular and Chronic Care in Sydney, Australia and lead author of the Cochrane Review. “This review also demonstrated good evidence for cost effectiveness for structured telephone support; however, the expense of telemonitoring has not been shown to have a cost benefit."