Result card

  • CUR5: What is the target population in this current assessment of Structured telephone support (STS) for adult patients with chronic heart failure?

What is the target population in this current assessment of Structured telephone support (STS) for adult patients with chronic heart failure?

Authors: Ingrid Wilbacher, Nadine Berndt, Francesca Gillespie

Internal reviewers: Alessandra Lo Scalzo, Christian Vladescu, Christina Mototolea, Kristina Lampe, Maria Camerlingo

For this AE the results of the CUR domain search were used. Most of the studies and literature reviews selected for the CUR domain provided some kind relevant information on the target population of the intervention. The two latest published guidelines of the European Society of Cardiology (ESC) on the diagnosis and treatment of HF and the website of the ESC were additionally consulted to find relevant answers to this AE.

Structured telephone support may not be suitable for every patient diagnosed with HF. According to Koehler et al. 2011 {64}, telemonitoring is particularly suitable for patients who are recently hospitalized due to HF, medically unstable, or classified being in the NYHA Class II and III. Koehler also recommends performing telemonitoring during the 12 event-free months after hospitalization for HF {64}. Since structured telephone support is one specific intervention of telemedicine, these eligibility criteria equally apply.

Guidelines of the ESC recommend remote monitoring of patients reporting symptoms (including drug adverse effects) and signs of HF (Class I recommendation, Level of Evidence: C) {19}.

Patients with cognitive impairment, a mental illness, a life expectancy less than one year, language barrier, hearing impairment, or another chronic disease are often not eligible for structured telephone support (Polisena et al., 2010) {93}. This has been confirmed by Paré et al. 2010 {92} who outlined on the basis of their systematic review on the clinical effects of home telemonitoring in the context of diabetes, asthma, HF and hypertension that telemonitoring likely to not be suitable for everyone, because most studies excluded patients with a moderate to severe cognitive, physical, visual or hearing disability. Patients who did not own a phone or who a very short life expectancy (less than 1 year) were often excluded as well. The beneficial effects on state of health are observed mostly among patients whose health state is rather serious {92}. However, the fact that certain groups have been excluded from studies does not mean that telemonitoring may not be suitable for them. According to the current literature this remains unknown and further research may identify if telemonitoring is also suitable for these patients.

In this current assessment of structured telephone support for adult patients with chronic heart failure, the target population concerns patients who have signs or symptoms of HF, or an underlying non-diagnosed abnormality of the cardiac structure that is likely to lead to HF.

Further considerations for the target population: According to the large number of studies that have been conducted on the clinical effectiveness of telemonitoring in HF patients, including structured telephone support, the appropriate target population generally concerns:  

-the elderly, with a definitive clinical diagnosis of HF;

-with a mean age generally around 70 years old (patients may also be significantly younger or older);

-or with chronic HF;

-often who have had a cardiovascular hospitalization or a hospitalization for HF within the previous 12 months;  

-who have been discharged to home;

-often with moderate or severe symptoms of HF (New York Heart Association, NYHA class II-IV), a LVEF ≤ 30 %;

-who are administered diuretics, ACE inhibitors and beta blockers.

In this group, the highest benefit of structured telemonitoring may be reached.

Wilbacher I et al. Result Card CUR5 In: Wilbacher I et al. Health Problem and Current Use of the Technology In: Jefferson T, Cerbo M, Vicari N [eds.]. Structured telephone support (STS) for adult patients with chronic heart failure [Core HTA], Agenas - Agenzia nazionale per i servizi sanitari regionali ; 2015. [cited 16 June 2021]. Available from: