This review indicates that remote monitoring programs may be a realistic option in expanding access to chronic heart failure programs, addressing some of the barriers of transport and funding. Patients with chronic heart failure are high users of health services. While multi-disciplinary approaches to improving outcomes are well established, access to these programs is limited. Remote monitoring programs reviewed in this study can reduce admissions to hospitals and overall mortality by nearly 20%, while improving overall quality of life for patients with chronic heart failure living in the community.

Background: The purpose of this article was to determine if specific types of remote monitoring technologies were better than others. Patients with chronic heart failure are high users of health services. While multi-disciplinary approaches to improving outcomes are well established, access to these programs is limited. Remote monitoring may be an alternative way of delivering care. Structured telephone support and telemonitoring (transferring physiological data using computer technology) have been studied frequently.

Methods: This review included studies where remote monitoring programs were managed by health professionals (e.g., nurses) and were aimed at patients with chronic heart failure living at home after being discharged from the hospital. A remote monitoring program needed to be structured (i.e., not "as needed"), carried out at least once in the first month after hospital discharge and was the only form of after care (i.e., no home care was provided). After searching several prominent medical databases and identifying relevant studies based on experts' opinions, the authors reviewed 14 studies evaluating remote monitoring programs published between 1999 and 2006.

Findings: Patients using any form of remote monitoring programs required fewer hospital admissions related to chronic heart failure. Compared with regular care patients, patients participating in remote monitoring programs reported improved health related quality of life (i.e., the impact of chronic heart failure on issues such as depression, financial costs, ability to perform daily physical activities, etc.). Both telemonitoring and structured telephone support were beneficial in reducing overall mortality by about 20% over standard care.

The authors did note, however, that remote monitoring, while seemingly effective for chronic heart failure, did not change the overall number of admissions for any other health issues when compared with regular care.Moreover, remote monitoring may be more effective at reducing the length of hospital stays rather than reducing the number of hospital admissions.

Conclusions: This review indicates that remote monitoring programs may be a realistic option in expanding access to chronic heart failure programs, addressing some of the barriers of transport and funding. Remote monitoring programs for patients with chronic heart failure living in the community can reduce admissions to hospitals and overall mortality by nearly 20%.

Reference: Clark RA, Inglis SC, McAlister FA, Cleland JGF, Stewart S. "Telemonitoring or structured telephone support programmes for patients with chronic heart failure: Systematic review and meta-analysis." BMJ 2007; 334, 942-951.

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