Result card

  • CUR11: What aspects of the consequences / burden of disease are targeted by Structured telephone support (STS) for adult patients with chronic heart failure?
English

What aspects of the consequences / burden of disease are targeted by 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

Basic search was used for this question and only articles reporting data related to the telemonitoring impact on the burden of disease were selected. No further research was needed. Systematic reviews and most recent article were taken in to account first. No quality assessment tool of articles was used. We just provide the  information relative to structured telephone support. 6 reviews were selected.

Telemonitoring impact on burden of heart failure is measured here as decrease in heart failure related hospitalization, heart failure related length of stay, and all cause mortality.

In short the listed reviews gave the foloowing information:

  • There is substantial heterogeneity in the results {33}.

  • Telehealth programmes demonstrated clinical effectiveness in patients with CHF compared with usual care {114}.

  • It was not clear as to the extent to which these effects were due to tele-monitoring per se or to the improvement in access to care {44}.

  • Structured telephone support and telemonitoring are effective in reducing the risk of all-causemortality andCHF-related hospitalisations; in patients with CHF; they improve quality of life, reduce costs, and evidence-based prescribing {48}.

  • Home telemonitoring is generally clinically effective, and no patient adverse events were reported in the included studies {93}.

  • Telemonitoring appears to be an acceptable method for monitoring of HF patients {75}.

The provided effectiveness data were

For mortality

  • Fixed effect model risk ratio 0.76, 95 % CI 0.66 to 0.88 {114} – mortality

  • hazard ratio [HR]: 0.97; p=0.87 {102}– mortality

  • RR 0.66; 95 % CI 0.54 - 0.81; P < 0.001 {48} for invasive telemonitoring – mortality

  • RR 0.88; 95 % CI 0.76 –{48} for structured telephone support– mortality

  • risk ratio ¼ 0.64; 95 % CI: 0.48–0.85 {93}– mortality

for CHF related hospitalisation

  • Random effect model risk ratio 0.72, 95 % CI 0.61 to 0.85 {114}– hospitalisation

  • hazard ratio (HR: 0.89; p=0.44 {102} – hospitalisation

  • RR 0.79; 95 % CI 0.67 - 0.94; P = 0.008 {48} for invasive telemonitoring – hospitalisation

  • RR 0.77; 95 % CI 0.68- 0.87; P < 0.0001). 1.01; P = 0.08 {48} for structured telephone support– hospitalisation

Gorthy 2014 {33} included in a systematic review 14 RCTs (from January 1975 to August 2014) evaluating the efficacy of non-invasive telemonitoring. 2 out of 12 studies reporting cardiac or all-cause mortality demonstrated a significantly positive effect, 3 out of 13 reported a significant reduction of all-cause hospitalization and 3 out of 10 reported reduction in HF hospitalization. 1 study demonstrated significant improvement of b-type naturetic peptide levels and quality of life using a mobile-phone-based telemonitoring system. 2 studies compared structured telephone support against non-invasive telemonitoring:

  • The first (TEN-HMS) randomized 426 patients to usual care (n = 85), structured telephone support (n = 173), or to non-invasive telemonitoring (n = 168)] demonstrated significant reduction in all-cause mortality of both intervention arms compared to usual care with no significant difference in HF/all-cause mortality and hospitalization between the two inteventions.

  • The second randomized 160 patients to usual care and 301 patients to one of three intervention groups. Strategy 1 employed structured telephone support alone (n = 104), strategy 2 employed structured telephone support plus weekly transmission of vital signs including changes in weight, blood pressure and symptoms (n = 96), and strategy 3 employed the same intervention used in strategy 2 plus a monthly 24-h cardiorespiratory recording (n = 101). All-cause hospitalization, HF hospitalization, and mortality were not significantly reduced in the more intensive strategy 2 and 3 intervention groups compared to strategy 1 patients. There was no significant effect of Home telemonitoring in reducing bed-days occupancy for HF or cardiac death plus HF hospitalization.

Gorthy et al. report substantial heterogeneity in the results. They mention that telephone or non-invasive telemonitoring have the advantage to reach large numbers of patients in regionally distant areas or are limited in travel. They assume that structured telephone support should be a relatively inexpensive treatment option. Non-invasive requires a certain degree of health-literacy of patients who must interact with the system to provide the information to the healthcare provider. The authors conclude that one approach applied to a broad spectrum of different patient types may not be effective.

Xiang 2013 {114} included in their systematic review 26 studies (of 33) concerning tele-monitoring from 2001-2012 with 7530 patients (15 of the 33 articles were in Gorthy 2004 review) and report within their meta-analysis that telehealth programmes had significant overall effectiveness in reducing all-cause mortality (Fixed effect model risk ratio 0.76, 95 % CI 0.66 to 0.88), CHF-related hospitalization (Random effect model risk ratio 0.72, 95 % CI 0.61 to 0.85) and CHF-related length of stay (Random effect model mean difference 21.41 days, 95 % CI 22.43 to 20.39). In addition, telehealth programmes showed significantly greater effectiveness in reducing mortality and hospitalizations among patients with higher New York Heart Association (NYHA) categories. The authors conclude that telehealth programmes demonstrated clinical effectiveness in patients with CHF compared with usual care.

A NICE 2010 Guidance {44} included 8 RCTs on telemonitoring from 2003-2010 (5 of these double with  in above listed articles). They report that the trials reviewed showed an improvement in all-cause mortality and all cause-hospitalisation rates when tele-monitoring, with intensive reviews and contact with the specialist team, was compared to standard care. The authors discuss that it was not clear as to the extent to which these effects were due to tele-monitoring per se or to the improvement in access to care by the patients assigned to tele-monitoring and no recommendation was made.

Inglis 2010 {48}, a Cochrane Review, included 27 controlled studies (from January 1966 to 6 May 2006) of which 11 used non-invasive telemonitoring (2,710 patients) and 16 used structured telephone support (5,613 patients) into a meta-analysis. The authors report an all-cause mortality significantly reduced by non-invasive telemonitoring (RR 0.66; 95 % CI 0.54 - 0.81; P < 0.001) but not by structured telephone support (RR 0.88; 95 % CI 0.76 – 1.01, P = 0.08). HF hospitalizations were significantly reduced by both telemonitoring (RR 0.79; 95 % CI 0.67 - 0.94; P = 0.008) and structured telephone support (RR 0.77; 95 % CI 0.68- 0.87; P < 0.0001). 1.01; P = 0.08). The authors conclude that structured telephone support and telemonitoring are effective in reducing the risk of all-causemortality and CHF-related hospitalisationsin patients with CHF; the interventions improve quality of life, reduce costs, and evidence-based prescribing.

Polisena 2010 {93} included 21 studies from 1998-2008 with 3082 patients in a systematic review and report that home telemonitoring reduced mortality (risk ratio ¼ 0.64; 95 % CI: 0.48–0.85) compared with usual care. Several studies suggested that home telemonitoring also helped to lower the number of hospitalizations and the use of other health services. Patient quality of life and satisfaction with home telemonitoring were similar or better than with usual care. The authors conclude that their review demonstrated that home telemonitoring is generally clinically effective, and no patient adverse events were reported in the included studies. More studies of higher methodological quality are required to give more precise information about the potential clinical effectiveness of home telehealth interventions.

Maric 2009 {75} included 56 articles on telemonitoring from before 2007 into a systematic review. The authors report that most studies demonstrated improvements in outcome measures, including improved quality of life and decreased hospitalizations. However, not all studies reported the same improvements and in several cases the sample sizes were relatively small. The authors conclude that telemonitoring appears to be an acceptable method for monitoring of HF patients. Controlled, randomized studies directly comparing different modalities and evaluating their success and feasibility when used as part of routine clinical care, are now required.

 

Critical
Partially
Wilbacher I et al. Result Card CUR11 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: http://corehta.info/ViewCover.aspx?id=305

References