A Cochrane review included 25 studies and 5 published abstracts. Of the 25 full peer-reviewed studies meta-analysed, 16 evaluated structured telephone support (n=5613), 11 evaluated telemonitoring (n=2710), and 2 tested both interventions (included in counts). Programmes were classified as structured telephone support if the monitoring and/or self-care management was delivered using simple telephone technology and telemonitoring if there was digital/broadband/satellite/wireless or blue-tooth transmission of physiologic and other non-invasive data. Telemonitoring reduced all-cause mortality (RR 0.66, 95% CI 0.54 to 0.81; 11 studies, n=2710) with structured telephone support demonstrating a non-significant positive effect (RR 0.88, 95% CI 0.76 to 1.01; 15 studies, n=5563). Both structured telephone support (RR 0.77, 95% CI 0.68 to 0.87; 13 studies, n=4269) and telemonitoring (RR 0.79, 95% CI 0.67 to 0.94; 4 studies, n=1570) reduced chronic heart failure (CHF)-related hospitalisations. For both interventions, several studies improved quality of life, reduced healthcare costs and were acceptable to patients. Improvements in prescribing, patient knowledge and self-care, and New York Heart Association (NYHA) functional class were observed.
Comment: The quality of evidence is downgraded by study quality (inadequate or unclear allocation concealment and blinding).