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The study found that patients assigned to HTM did not have significantly fewer days dead or hospitalized the primary study endpoint than patients assigned to NTS or UC.
Home telemonitoring consisted of twice-daily patient self-measurement of weight, BP, HR, and rhythm with automated devices linked to a cardiology center. The NTS consisted of specialist nurses who were available to patients by telephone. Primary care physicians delivered UC. The investigators reported that, during days of follow-up, there was no statistically significant difference in the days that were lost as the result of death or hospitalization for UC, NTS, and HTM.
The number of admissions and mortality were similar among patients randomly assigned to NTS or HTM, but the mean duration of admission was less in patients assigned to HTM. Two studies directly compared effectiveness of 2 or more forms of telemonitoring. Study quality and intervention type varied considerably.
Of the 3 negative studies, 2 enrolled low-risk patients and patients with access to high quality care, whereas 1 enrolled a very high-risk Hispanic population. Studies comparing forms of telemonitoring demonstrated similar effectiveness.
The authors concluded that the evidence base for telemonitoring in heart failure is currently quite limited. Furthermore, an ey online writing assessment published in the British Medical Journal Grancelli and Ferrante,which addressed another systematic evidence review found similar results with simple telephone interventions compared to complex congestive heart failure telemonitoring.
Dang et al evaluated the evidence base for the use of home telehealth remote monitoring in elderly with congestive heart failure CHF.
The ey online writing assessment was restricted to randomized controlled trials using either automated monitoring of signs and symptoms or automated physiologic monitoring. For this review, telephone-based monitoring of signs and symptoms was not considered remote monitoring.
Studies were also excluded if they did not present outcomes related to healthcare utilization. Two studies showed significant reduction in the number of Emergency Department visits. Available data suggest that telemonitoring is a promising strategy. The authors stated that more data are needed to determine the ideal patient population, technology, and parameters, frequency and duration of telemonitoring, and the exact combination of case management and close monitoring that would assure consistent and improved outcomes with cost reductions in CHF.
Mortara and co-workers assessed the feasibility of a new system of HTM. The HTM system was used to monitor clinical and physiological parameters, and its effectiveness compared with usual care in reducing cardiac events in heart failure HF patients was evaluated. Over a month follow-up, there was no significant effect of HTM in reducing bed-days occupancy for HF or cardiac death plus HF hospitalization.
The authors concluded that Home or Hospital in Heart Failure Study indicated that self-managed HTM of clinical and physiological parameters is feasible in HF patients, with surprisingly high compliance.
Whether HTM contributes to a reduction of cardiac events requires further investigation. Schmidt and colleagues reviewed the current status of health services research on telemonitoring, focusing on patients with chronic CHF.
The Medline database was selectively searched for articles appearing from June to Maywith an emphasis on randomized, controlled trials.
The available scientific data on vital signs monitoring are limited, yet there is evidence for a positive effect on some clinical endpoints, particularly mortality. However, any possible improvement of patient-reported outcomes, such as the quality of life, still remains to be demonstrated.
A valid criticism is that the individual components of HTM have not yet been separately tested in order to compare their individual effects. Polisena and associates conducted a systematic review of the literature about HTM compared with usual care.
Several studies suggested that HTM also helped to lower the number of hospitalizations and the use of other health services.
Patient quality of life and satisfaction with HTM were similar or better than with usual care. Koehler et al examined if physician-led remote telemedical management RTM compared with usual care would result in reduced mortality in ambulatory patients with CHF.
Patients were randomly assigned 1: Remote telemedical management used portable devices for ECG, BP, and body weight measurements connected to a personal digital assistant that sent automated encrypted transmission via cell phones to the telemedical centers.
The primary end point was death from any cause. The first secondary end point was a composite of cardiovascular death and hospitalization for HF. The median follow-up was 26 months minimum 12and was Compared with usual care, RTM had no significant effect on all-cause mortality hazard ratio, 0.
The authors concluded that in ambulatory patients with CHF, RTM compared with usual care was not associated with a reduction in all-cause mortality. An assessment by the California Technology Assessment Forum Tice, found that home telemonitoring for patients with heart failure does not meet CTAF TA Criterion 3 through 5 for safety, effectiveness and improvement in health outcomes.
CTAF's systematic review of the literature identified 17 trials that randomized patients to evaluate the efficacy of home telemonitoring. The settings, patient populations, interventions, control groups, outcomes and length of follow-up varied widely between the studies.
Because of the heterogeneity in the trials and their outcomes,CTAF performed no formal metaanalysis. CTAF noted that neither study found any benefit to home monitoring compared with usual care.The writing assessment has a limitation of 45 mins, and my topic was "recent events in the financial industry that has impact" or something like that.
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