Skip Navigation

European Journal of Heart Failure 2003 5(5):583-590; doi:10.1016/S1388-9842(03)00160-0
This Article
Right arrow Abstract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Louis, A. A.
Right arrow Articles by Cleland, J. G.F.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Louis, A. A.
Right arrow Articles by Cleland, J. G.F.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

© 2003 European Society of Cardiology

A systematic review of telemonitoring for the management of heart failure

Amala A. Louis, Tracy Turner, Marcia Gretton, Angela Baksh and John G.F. Cleland*

Department of Cardiology, University of Hull, Castle Hill Hospital Kingston upon Hull, UK

* Corresponding author. Tel.: +44-1482-624-087; fax: +44-1482-624-085. E-mail address: g.m.porter{at}hull.ac.uk


   Abstract
Top
 Abstract
1. Introduction
 2. Methods
 3. Results
 4. Discussion
 References
 
Background: Telemonitoring allows a clinician to monitor, on a daily basis, physiological variables measured by patients at home. This provides a means to keep patients with heart failure under close supervision, which could reduce the rate of admission to hospital and accelerate discharge.

Objective: To review the literature on the application of telemedicine in the management of heart failure.

Methods: A literature search was conducted on studies involving telemonitoring and heart failure between 1966 and 2002 using Medline, Embase, Cochrane Library and Journal of Telemedicine and Telecare.

Results: Eighteen observational studies and six randomised controlled trials involving telemonitoring and heart failure were identified. Observational studies suggest that telemonitoring; used either alone or as part of a multidisciplinary care program, reduce hospital bed-days occupancy. Patient acceptance of and compliance with telemonitoring was high. Two randomised controlled trials suggest that telemonitoring of vital signs and symptoms facilitate early detection of deterioration and reduce readmission rates and length of hospital stay in patients with heart failure. One study also showed a reduction in readmission charges. One substantial randomised controlled study showed a significant reduction in mortality at 6 months by monitoring weight and symptoms in patients with heart failure; however, no difference was observed in readmission rates. Another randomised study comparing video-consultation performed as part of a home health care programme for patients with a variety of diagnoses, suggested a reduction in the costs of hospital care, which offset the cost of video-consultation. Patients with heart failure were not reported separately. One randomised study showed no difference in outcomes between the telemonitoring group and the standard care group.

Conclusion: Telemonitoring might have an important role as part of a strategy for the delivery of effective health care for patients with heart failure. Adequately powered multicentre, randomised controlled trials are required to further evaluate the potential benefits and cost-effectiveness of this intervention.

Key Words: Heart failure • Telemonitoring • Telemedicine

Received November 4, 2002; Revised June 16, 2003; Accepted August 28, 2003


   1. Introduction
Top
 Abstract
 1. Introduction
2. Methods
 3. Results
 4. Discussion
 References
 
Telemonitoring permits home monitoring of patients using special telecare devices in conjunction with a telecommunication system, either standard telephone lines, cable-networks or broad-band technology. Telemonitoring allows evaluation of patients once or more per day or even continuous monitoring. It can provide diagnostic information, which can be transmitted manually or automatically to those with expertise in interpreting the data. This may assist in management decisions. Telecare is increasingly being used by care providers in various specialties to support chronically ill patients at home using existing telecommunications systems [1,2]. Interest in telecare as a viable alternative for the provision of care has been stimulated by the rising costs of care in hospital, rapid advances in communication and diagnostic technology and the wider availability of low-cost, patient-friendly telecare equipment.

Heart failure is common, is the most common cause of hospitalization due to cardiovascular disease in patients over 65 years of age [3] and has a considerable impact on healthcare costs [4,5]. Studies have shown that 30% of patients with a discharge diagnosis of heart failure are readmitted at least once within 90 days [6] and readmission rates range from 25 to 54% within 3–6 months [7–12]. There is some evidence that a multidisciplinary management program and home-based intervention can reduce readmission rates and length of hospital stay in heart failure patients [13–18]. Telemonitoring could further enhance the provision of home-based care, facilitating delivery of effective medical therapy, improving patients’ quality of life and reducing the duration and frequency of hospital admission.

This systematic review looks at the current evidence on telemonitoring as a means of reducing hospitalisations in patients with heart failure. The deficiencies in the available evidence are identified and future areas of research suggested.


   2. Methods
Top
 Abstract
 1. Introduction
 2. Methods
3. Results
 4. Discussion
 References
 
Studies involving telemonitoring in heart failure were identified by searching the literature for studies conducted on the use of telemonitoring in heart failure from 1966 to 2002. The following electronic databases were searched: Medline, Embase and the Cochrane library, we also searched the Journal of Telemedicine and Telecare for articles not included in the above databases. Abstracts presented at the international meetings between 1996 and 2002 were also reviewed.

The keywords used were: heart failure, congestive heart failure, cardiac failure, telemedicine, telecare, telemonitoring, teleconsultation, teleconference and telecommunications. Articles of possible interest were obtained and read by two reviewers to identify whether they should be included. Reference lists from published articles were also scrutinized to identify any further relevant papers.

Telemonitoring was defined as home monitoring of patients using special telecare devices in conjunction with a telecommunication system. Studies that included only regular telephone calls by care-providers without specialized home monitoring equipment were not included. We excluded review papers and studies where heart failure patients were not included or not reported. However, studies in which only a subgroup of patients was telemonitored for heart failure were retained in the analysis. Studies with multiple publications were identified to avoid duplicate reporting.


   3. Results
Top
 Abstract
 1. Introduction
 2. Methods
 3. Results
4. Discussion
 References
 
3.1. Acceptability of telemonitoring to patients
Six observational studies [19–24] (Table 1) and one randomised study [25] (Table 2) assessed the patients’ acceptance of and compliance with telemonitoring. They showed good acceptability ranging from 80–90%. Five studies monitored weight, two monitored blood pressure and heart rate whilst one monitored ECG in addition to respiratory rate and body temperature; this study also included non-heart failure patients [19]. One study used pacemaker based bio-impedance monitoring of extracellular fluid to free fat mass ratio, as part of a protocol driven diuretic dosing system in patients with severe heart failure, to detect acute episodes of fluid overload [20]. Telemonitoring was associated with an improved quality of life in heart failure patients [21]. However, these studies were non-randomised, uncontrolled and only involved few patients.


View this table:
[in this window]
[in a new window]

  		Table 1 Observational Studies assessing patient acceptability and satisfaction with telemonitoring in heart failure

 


View this table:
[in this window]
[in a new window]

  		Table 2 Randomised controlled trials on the role of telemonitoring in management of patients with heart failure

 
Woodend et al. [25], showed high patient satisfaction to video-conference with a nurse and telemonitoring of vital signs and ECG, in a randomised controlled trial comparing telemonitoring with usual care. This study also showed an improvement in quality of life with telemonitoring.

3.2. Hospitalization and mortality
Twelve non-randomised studies [26–37] and four randomised studies [38–41] assessed the effect of telemonitoring on hospitalisations and readmission rates (Tables 2 and 3). Fourteen studies involved weight monitoring, five studies monitored blood pressure, two studies used ECG monitoring and two used transcutaneous O2 saturations.


View this table:
[in this window]
[in a new window]

  		Table 3 Non-randomised studies on telemonitoring and hospitalizations and readmission rates in patients with heart failure

 
3.3. Hospitalizations and mortality: observational studies
Observational studies showed a significant reduction in hospitalisations and readmission rates and one study also showed there was a reduction in reimbursement claims associated with hospitalizations [30]. Roglieri et al. [31] noticed a 75% reduction in 30-day readmission rate (P=0.02) and 74% reduction in 90-day readmission rate (P=0.004). Bondmass et al. [29] showed that readmissions with heart failure were fewer and associated with reduced length of hospital stay, when weight, blood pressure, pulse and oxygen saturation were monitored in patients with advanced heart failure and when compared to patients receiving nurse visit alone. However, these studies only involved few patients and some used other measures like patient education, automated medication reminders and regular out-patient follow up in combination with telemonitoring, therefore, it is difficult to determine to what extent any beneficial effect on outcome was due to telemonitoring.

3.4. Hospitalizations and mortality: randomised studies
Goldberg et al. showed that telemonitoring of weight and symptoms reduced mortality significantly, most markedly in women and patients aged <65 years, compared to standard care [38]. However, this was not the primary endpoint of the study, which was 180-day readmission rate, where no significant differences were noticed compared to standard care. Jerant et al. [40] compared usual care with nurse telephone support and home telemonitoring in a study of just 37 patients. A reduction in hospitalisation was reported compared to usual care with either strategy but exact details have not been reported. Bondmass et al. [39], in a short study comparing nurse telemanagement with nurse home visits, showed telemonitoring was superior to home visits in reducing readmission rates and length of hospital stay. Improved quality of life scores were also observed. Massie et al. [41] randomised 147 patients to usual care, weekly nurse telephone contact and telemonitoring of ‘vital signs and symptoms’ and followed them for a mean of 8 months. The primary endpoint of death or re-hospitalisation was not significantly different between care strategies, although there was a trend in favour of home telemonitoring. Thus, perhaps two [39,40] out of four randomised studies showed a significant reduction in hospitalisations and readmission rates in patients with heart failure.

3.5. Cost effectiveness
Only five out of the twenty-four studies assessed the cost benefit of telemonitoring [30,33,34,40,42]. Heidenrich et al. [30] showed that implementation of a telemonitoring programme decreased annual medical costs compared with the previous year. Ertle et al. [34], by telemonitoring weight and symptoms, showed a 73% reduction in inpatient costs compared to costs prior to intervention. Johnson et al., in a randomised controlled trial [42] showed that incorporation of video consultations into a routine home health care programme (home visits and telephone contact) reduced the overall costs of health care. The total mean cost of care excluding home health care costs was $1948 in the intervention group and $2674 in the control group. This reduction in cost was mainly attributable to hospitalization costs, which were $1940 in the control group and $1087 in the teleconsultation group. However, the overall reduction in cost was assessed for the management of a variety of diseases in the intervention group, the benefit in patients with heart failure was not specifically evaluated. In a small randomised trial, Jerant et al. [40] found that heart failure related readmission charges were 86% lower in the telecare group (n=13) and 84% lower in the telephone follow-up group (n=12) compared with usual care (n=12); however, there was no significant difference in the cost reduction between the telecare group and the telephone follow up group. The study was not adequately powered to exclude important differences between the monitoring groups.


   4. Discussion
Top
 Abstract
 1. Introduction
 2. Methods
 3. Results
 4. Discussion
References
 
Observational studies have suggested that telemonitoring, either used alone or as part of a multidisciplinary approach, may reduce hospitalisations and readmission rates in patients with heart failure. This review suggests that telemonitoring may improve morbidity and mortality in patients with heart failure. However, these data need to be confirmed in larger, long-term studies that are adequately powered for clinical relevant outcomes. Telemonitoring may be disadvantaged by the potentially steep learning curve, for both patient and care-provider, associated with this technology. Clearly, the full potential of home telemonitoring may not have been realised and further clinical trials are needed. Telemonitoring must not only prove that it is effective but also that it is more effective than simpler interventions.

Heart failure is a leading cause for hospital admission [6]. Admissions are often prolonged and recurrent. This is unfortunate for patients, who spend a high proportion of their remaining life in hospital, problematic for hospitals due to the limited amount of resources available and expensive for health care systems, as bed-days occupancy is an important component of the costs of care. A high proportion of patients die or are readmitted within a few weeks of discharge, which may be exacerbated by premature discharge leading to worse outcomes and/or increased costs. These problems are likely to increase over the next few decades as the longevity of the population increases. There is a need for more effective techniques to reduce or at least prevent an increase in the frequency and duration of admissions.

Telemonitoring could reduce the frequency of admissions for a variety of reasons. Monitoring weight as a measure of fluid balance allows diuretics to be adjusted to improve or prevent worsening of symptoms of heart failure but at the same time avoiding over-diuresis, which could lead to hospital admission with uraemia. Early detection and management of precipitating factors for heart failure such as new-onset atrial fibrillation, infection or persistent hypertension, could also reduce admissions. Optimum medical treatment with ACE Inhibitors, beta-blockers and aldosterone antagonists is important in the management of patients with heart failure due to left ventricular systolic dysfunction [43,44]. Most patients with heart failure are now started on appropriate therapy, but titration to achieve the target doses recommended in clinical guidelines is often not done. Home monitoring of blood pressure and heart rate could assist in the uptitration of ACE inhibitors and beta-blockers. Use of telemonitoring in this way could reduce the number of hospital visits for the patient and the duration of consultation, increasing the likelihood that uptitration will occur. Improved medical management could, in turn, lead to a reduction in the need for hospitalisation and an improvement in the quality and quantity of life.

Experience suggests that, of currently available measures, weight may be the most useful for home monitoring of patients with heart failure as a rough measure of fluid balance. This may help in the early detection of fluid retention or excessive diuresis, allowing diuretic dose to be adjusted to prevent a crisis. Bio-impedance techniques could be used to gauge fluid balance more accurately [45,46].

Blood pressure and heart rate may be useful aids in monitoring and uptitrating therapy. New non-invasive oscillometric techniques for analysing the arterial pressure waveform may permit haemodynamic telemonitoring [47]. Alternatively, implantable haemodynamic monitoring devices may soon be commercially available [48]. The ECG [19,35] may be useful for the early detection of atrial fibrillation, which may have important therapeutic implications in terms of anti-coagulation, ventricular rate control and cardioversion. Monitoring of transcutaneous oxygen saturation [29,39] may be important for the detection and monitoring of sleep apnoea, a common problem in heart failure; a large randomised controlled trial (CANPAP) [49] is currently underway to determine whether treatment of this problem is of benefit in patients with heart failure. The importance of measuring respiratory rate is less clear, since it is likely to be a very late marker of worsening heart failure. Monitoring of temperature [19] could assist in the tele-diagnosis of infection as a cause of worsening symptoms. In the future, telemonitoring of essential biochemistry such as urea, creatinine, potassium and natriuretic peptides may be feasible. The sophistication of the technology used will be determined by the evidence for the utility of the variables monitored, their cost, the risk profile of the patient and the difficulty of patient access to direct medical care, for example due to the distance that the patient lives from the expert centre.

Preliminary data from two large trials have been presented at meetings. Both provide further evidence that some form of home telephone or telemonitoring care may reduce hospital admissions and mortality. The TEN-HMS trial (Trans-European Network initiative—Homecare Management System study) randomised 426 patients to usual care, nurse telephone support or home telemonitoring and identified that both interventions were associated with a substantial reduction in mortality [50]. Although the DIAL trial (ranDomised trial of telephonic Intervention in chronic heArt faiLure) is not strictly within the scope of this review, since it required no specialized monitoring equipment in the patients home, it is the largest outcome study in this area and, therefore, worthy of mention. In the DIAL trial, 1518 patients were randomised to usual care or nurse telephone support and followed for approximately 15 months. Mortality was unaffected but heart failure admissions were reduced by 29% [51].

In conclusion, telemonitoring might have an important role as part of a strategy for the delivery of effective health care for patients with heart failure but more evidence of efficacy is required before its widespread adoption can be recommended. Furthermore, analysis of existing studies and new large multicentre, randomised controlled trials are necessary to evaluate the potential benefits and cost-effectiveness of this evolving intervention.


   References
Top
 Abstract
 1. Introduction
 2. Methods
 3. Results
 4. Discussion
 References
 

  1. Billard A., Rohmer V., Roques M.A., Joseph M.G., et al. Telematic transmission of computerized blood glucose profiles for IDDM patients. Diabetes Care (1991) 14:130–134.[Abstract]
  2. Ahring K.K., Ahring J.P., Joyce C., Farid N.R. Telephone modem access improves diabetes control in those with insulin requiring diabetes. Diabetes Care (1992) 15:971–975.[Abstract]
  3. Cowie M.R., Mosterd A., Wood D.A., et al. The epidemiology of heart failure. Eur Heart J (1997) 18:208–255.[Free Full Text]
  4. O'Connell J.B., Bristow M. Economic impact of heart failure in the United States: time for a different approach. J Heart Lung Transplant (1993) 13:S107–S112.[Web of Science]
  5. Cline C., Broms K., Willenheimer R., et al. Hospitalisations and health care costs due to congestive heart failure in the elderly. Am J Geriatr Cardiol (1996) 5:10–23.[Medline]
  6. Cleland J.G.F., Gemmell I., Khand A., Boddy A. Is the prognosis of heart failure improving? Eur J Heart Fail (1999) 1:229–241.[Abstract/Free Full Text]
  7. Rich M., Beckham V., Wittenberg C., Leven C., Freeland K., Carney R. Repetitive hospital admissions for congestive heart failure in the elderly. Am J Geriatr Cardiol (1996) 5:32–35.[Medline]
  8. Vinson J.M., Rich M.W., Sperry J.C., Shah A.S., McNamara T. Early readmission of elderly patients with congestive heart failure. J Am Geriatr Soc (1990) 38:1290–1295.[Web of Science][Medline]
  9. Krumholz H.M., Parent E.M., Tu N., Vaccarino V., Wang Y., Radford M.J., et al. Readmission after hospitalization for congestive heart failure among medicare beneficiaries. Arch Intern Med (1997) 157:99–104.[Abstract/Free Full Text]
  10. Wolinsky F.D., Smith D.M., Stump T.E., Overhage J.M., Lubitz R.M. The sequelae of hospitalisation for congestive heart failure among older adults. J Am Geriatr Soc (1997) 45:558–563.[Web of Science][Medline]
  11. Burns R.B., McCarthy E.P., Moskowitz M.A., Ash A., Kane R.L., Finch M. Outcomes for older men and women with congestive heart failure. J Am Geriatr Soc (1997) 45:270–275.[Web of Science][Medline]
  12. Komajda M., Follath F., Swedberg K., Cleland J., et al. The euroheart failure survey programme—a survey on the quality of care among patients with heart failure in Europe. Part 2: treatment. Eur Heart J (2003) 24(5):464–474.[Abstract/Free Full Text]
  13. Stewart S., Marley J.E., Horowitz J.D. Effects of a multidisciplinary, home-based intervention on unplanned readmission and survival among patients with chronic congestive heart failure: a randomised controlled study. Lancet (1999) 354:1077–1083.[CrossRef][Web of Science][Medline]
  14. Rich M., Beckham V., Wittenberg C., Leven C., Freeland K., Carney R. A multidisciplinary intervention to prevent the readmission of elderly patients with heart failure. N Engl J Med (1995) 333:1190–1195.[Abstract/Free Full Text]
  15. Cline C.M.J., Israelsson B.Y.A., Willenheimer R.B., Broms K., Erhardt L.R. Cost effective management programme for heart failure reduces hospitalization. Heart (1998) 80:442–446.[Abstract/Free Full Text]
  16. Fonarow G.C., Stevenson L.W., Walden J.A., Livingston N.A., Steimle A.E., Hamilton M.A., et al. Impact of a comprehensive heart failure management program on hospital readmission and functional status of patients with advanced heart failure. J Am Coll Cardiol (1997) 30:725–732.[Abstract]
  17. Kornowski R., Zeeli D., Averbuch M., Finkelstein A., Schwartz D., Moshkowitz M., et al. Intensive home-care surveillance prevents hospitalizations and improves morbidity rates among elderly patients with severe congestive heart failure. Am Heart J (1995) 129:762–766.[CrossRef][Web of Science][Medline]
  18. Blue L., Lang E., McMurray J.J.V., Davie A.P., McDonagh T.A., Murdoch D.R., et al. Randomised controlled trial of specialist nurse intervention in heart failure. BMJ (2001) 323:715–718.[Abstract/Free Full Text]
  19. de Lusignan S., Althans A., Wells S., Johnson P., Vandenberg M., Robinson J. A pilot study of radiotelemetry for continuous cardiopulmonary monitoring of patients at home. J Telemed Telecare (2000) 6(Suppl_1):119–122.[Free Full Text]
  20. Wang L., Yu C.-M., Chau E., Lam W.-F. Feasibility of predicting CHF hospitalization using pacemaker-based impedance sensor in CHF patients. J Card Fail (2002) 8:S81.
  21. de Lusignan S., Meredith K., Wells S., Leatham E., Johnson P. A controlled pilot study in the use of telemedicine in the community on the management of heart failure. Stud Health Technol Inf (1999) 64:126–137.
  22. Deering M., Baines B., Christianson C., Milner J. Patients and providers evaluate daily home weight and symptom monitoring for CHF management. J Card Fail (2002) 8:S97.
  23. Knox D.A., Mueller T.M., Vuckovic K.M., Acker K. Remote titration of beta blocker therapy for heart failure by advanced practice nurses, titration protocols and daily patient telemanagement. J Card Fail (2002) 8:S83.
  24. Williams RE, Keiler L, Sprang M, Mehan C. Telemanagement of congestive heart failure: results of daily weight and symptom tracking. American College of Cardiology annual scientific session 1998; Abstract 977–177.
  25. Woodend A.K., Fraser M., Sherrard H., Stueve L. Readmission and quality of life: the impact of telehome care in heart failure. J Card Fail (2002) 8:S98.
  26. Shah N.B., Der E., Ruggerio C., Heidenrich P.A., Massie B.M. Prevention of hospitalizations for heart failure with an interactive home monitoring program. Am Heart J (1998) 373–377.
  27. Cordisco M.E., Beniaminovitz A., Hammond K., Mancini D. Use of telemonitoring to decrease the rate of hospitalization in patients with severe congestive heart failure. Am J Cardiol (1999) 84:860–862.[CrossRef][Web of Science][Medline]
  28. Chrysegolos E.T., Gemme D., Coleman K., Chung E.S., Meyer T.E. Telemonitoring devices further improve outcomes of a multidisciplinary heart failure outpatient program. J Card Fail (1999) 5(3):73. Suppl. 1.
  29. Bondmass M., Malhotra V., Castro G., Avitall B. The long-term effect of telemedicine intervention on heart failure admissions and length of stay. J Card Fail (1999) 5(3):78. Suppl. 1: Abstr 293.
  30. Heidenrich P.A., Ruggerio C.M., Massie B.M. Effect of a home monitoring system on hospitalization and resource use for patients with heart failure. Am Heart J (1999) 138:633–640.[CrossRef][Web of Science][Medline]
  31. Roglieri J.L., Futterman R., Mc Donough K.L., Malya G., Karwath K.R., Bowman D., et al. Disease management interventions to improve outcomes in congestive heart failure. Am J Manage Care (Dec 1997) 3(12):1831–1839.[Web of Science][Medline]
  32. Macropoulos L.R., Selna M.J. CHF hospital admissions reduced by 48% (to 0.272 PPPY at 360 days) in large medicare population using advanced home monitoring program. J Card Fail (2002) 8:S97.
  33. Kesinger T., Gilani S., Jennison S.H. Electronic home monitoring reduces hospital admission, length of stay and readmission frequency in a selected heart failure population. J Card Fail (2002) 8:S94.
  34. Ertle D., Litman G.I. Hospital outpatient disease management initiative achieves marked reduction in inpatient admissions and costs for congestive heart failure. J Card Fail (2002) 8:S90.
  35. Scalvini S., Zanelli E., Volterrani M., Benigno M. Effect of a home based telecardiology on chronic heart failure outcomes: a case control pilot study. Eur J Heart Fail (2002) 1:72.
  36. Feldman C.L., Milstein S.Z., Cinnamond M.D., Maslow G.L., et al. A protocol driven diuretic dosing system based on bioelectric impedance reduces acute episodes of fluid overload in patients with severe heart failure while minimizing physician management time. J Card Fail (2002) 8:S84.
  37. Lapworth D.J., Dibiase A. Decreased hospitalizations using a home based electronic weight monitoring system as part of a comprehensive heart failure program. J Card Fail (2000) 6:69.
  38. Goldberg L.R., Piette J.D., Walsh M.N., Frank T.A., Jaski B., et al. A daily electronic home monitoring system in patients with advanced heart failure improves survival: the WHARF (weight monitoring in heart failure) trial. J Card Fail (2002) 8:S54.
  39. Bondmass M., Benatar J.D., Castro G., Avitall B. A prospective randomised study comparing outcomes and outpatient care delivery methods for chronic heart failure. J Am Coll Cardiol (2001) 37:1A–648A.[Medline]
  40. Jerant A.F., Azari R., Nesbitt T.S. Reducing the costs of frequent hospital admissions for congestive heart failure: a randomised trial of a home telecare intervention. Med Care (Nov 2001) 39(11):1234–1245.[CrossRef][Web of Science][Medline]
  41. Massie B.M., West J., Van Ostaeyen D., Salbalvaro A. A controlled trial of heart failure management programs. J Am Coll Cardiol (2001) 37:1A–648A.[Medline]
  42. Johnson B., Wheeler L., Deuser J., Sousa K.H. Outcomes of the Kaiser Permanente tele home health research project. Arch Fam Med (2000) 9(Part 1):40–45.[Abstract/Free Full Text]
  43. Remme W.J., Swedberg K. European society of cardiology. Comprehensive guidelines for the diagnosis and treatment of chronic heart failure. Task force for the diagnosis and treatment of chronic heart failure of the European society of cardiology. Eur J Heart Fail (2002) 4(1):11–22.[Free Full Text]
  44. Cleland JGF, Clark AL. Delivering the cumulative benefits of triple therapy to improve outcomes in heart failure. J Am Coll Cardiol 2003 (in press).
  45. Cox-Reijven P.L., Soeters P.B. Validation of bio-impedance spectroscopy: effects of degree of obesity and ways of calculating volumes from measured resistance values. Int J Obes (2000) 24(3):271–280.[CrossRef][Web of Science][Medline]
  46. Raaijmakers E., Faes T.J., Meijer J.M., Kunst P.W., Bakker J., Goovaerts H.G., et al. Estimation of non-cardiogenic pulmonary oedema using dual-frequency electrical impedance. Med Bio Eng Computing (1998) 36(4):461–466.[CrossRef]
  47. Brinton T.J., Cotter B., Kailasam M.T., Brown D.L., Chio S., O'Connor D.T., et al. Development and validation of a non-invasive method to determine arterial pressure and vascular compliance. Am J Cardiol (1997) 80:323–330.[CrossRef][Web of Science][Medline]
  48. Ohlsson A., Bennett T., Ottenhoff F., Bitkover C., Kjellstrom B., Nordlander R., et al. Long-term recording of cardiac output via an implantable haemodynamic monitoring device. Eur Heart J (1996) 17(12):1902–1910.[Abstract/Free Full Text]
  49. Sin D.D., Logan A.G., Fitzgerald F.S., Liu P.P., Bradley T.D. Effects of continuous positive airway pressure on cardiovascular outcomes in heart failure patients with and without Cheyne–Stokes respiration. Circulation (2000) 102:61–66.[Abstract/Free Full Text]
  50. Cleland, JG, Louis, AA, Balk, A, Jansens, U. Trans-European network initiative homecare management (TEN-HMS) study. European Society of Cardiology hotline session, 2002.
  51. Coletta A.P., Nikitin N., Clark A.L., Cleland J.G.F. Clinical trials update from the AHA meeting: PROSPER, DIAL, home monitoring trials, immune modulation therapy, COMPANION and anaemia in heart failure. Eur J Heart Fail (2003) 5:95–99.[Abstract/Free Full Text]

Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?


This article has been cited by other articles:


Home page
 Eur J Heart FailHome page
J. Zhang, K. M. Goode, P. E. Cuddihy, J. G.F. Cleland, and on behalf of the TEN-HMS Investigators
Predicting hospitalization due to worsening heart failure using daily weight measurement: analysis of the Trans-European Network-Home-Care Management System (TEN-HMS) study
Eur J Heart Fail, April 1, 2009; 11(4): 420 - 427.
[Abstract] [Full Text] [PDF]

Home page
 Eur J Heart FailHome page
A. Arya, M. Block, J. Kautzner, T. Lewalter, H. Mortel, S. Sack, B. Schumacher, P. Sogaard, M. Taborsky, D. Husser, et al.
Influence of Home Monitoring on the clinical status of heart failure patients: Design and rationale of the IN-TIME study
Eur J Heart Fail, November 1, 2008; 10(11): 1143 - 1148.
[Abstract] [Full Text] [PDF]

Home page
 J Telemed TelecareHome page
R. Antonicelli, P. Testarmata, L. Spazzafumo, C. Gagliardi, G. Bilo, M. Valentini, F. Olivieri, and G. Parati
Impact of telemonitoring at home on the management of elderly patients with congestive heart failure
J Telemed Telecare, September 1, 2008; 14(6): 300 - 305.
[Abstract] [Full Text] [PDF]

Home page
 EuropaceHome page
E. Page, S. Cazeau, P. Ritter, D. Galley, and C. Casset
Physiological approach to monitor patients in congestive heart failure: application of a new implantable device-based system to monitor daily life activity and ventilation
Europace, August 1, 2007; 9(8): 687 - 693.
[Abstract] [Full Text] [PDF]

Home page
 J. Am. Med. Inform. Assoc.Home page
G. Pare, M. Jaana, and C. Sicotte
Systematic Review of Home Telemonitoring for Chronic Diseases: The Evidence Base
J. Am. Med. Inform. Assoc., May 1, 2007; 14(3): 269 - 277.
[Abstract] [Full Text] [PDF]

Home page
 Home Health Care Management PracticeHome page
S. Myers, R. W. Grant, N. E. Lugn, B. Holbert, and J. C. Kvedar
Impact of Home-Based Monitoring on the Care of Patients with Congestive Heart Failure
Home Health Care Management Practice, October 1, 2006; 18(6): 444 - 451.
[Abstract] [PDF]

Home page
 Eur J Heart FailHome page
J. G.F. Cleland, A. P. Coletta, and A. L. Clark
Clinical trials update from the joint European Society and World Congress of Cardiology meeting: PEP-CHF, ACCLAIM and the HHH study
Eur J Heart Fail, October 1, 2006; 8(6): 658 - 661.
[Abstract] [Full Text] [PDF]

Home page
 CirculationHome page
C.-M. Yu, L. Wang, E. Chau, R. H.-W. Chan, S.-L. Kong, M.-O. Tang, J. Christensen, R. W. Stadler, and C.-P. Lau
Intrathoracic Impedance Monitoring in Patients With Heart Failure: Correlation With Fluid Status and Feasibility of Early Warning Preceding Hospitalization
Circulation, August 9, 2005; 112(6): 841 - 848.
[Abstract] [Full Text] [PDF]

Home page
 HeartHome page
T. Jaarsma
Inter-professional team approach to patients with heart failure
Heart, June 1, 2005; 91(6): 832 - 838.
[Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
J. G.F. Cleland, A. A. Louis, A. S. Rigby, U. Janssens, A. H.M.M. Balk, and TEN-HMS Investigators
Noninvasive Home Telemonitoring for Patients With Heart Failure at High Risk of Recurrent Admission and Death: The Trans-European Network-Home-Care Management System (TEN-HMS) study
J. Am. Coll. Cardiol., May 17, 2005; 45(10): 1654 - 1664.
[Abstract] [Full Text] [PDF]

Home page
 Eur J Heart FailHome page
A. Stromberg
The crucial role of patient education in heart failure
Eur J Heart Fail, March 16, 2005; 7(3): 363 - 369.
[Abstract] [Full Text] [PDF]

Home page
 Eur J Heart FailHome page
D. R. Thompson, A. Roebuck, and S. Stewart
Effects of a nurse-led, clinic and home-based intervention on recurrent hospital use in chronic heart failure
Eur J Heart Fail, March 16, 2005; 7(3): 377 - 384.
[Abstract] [Full Text] [PDF]

Home page
 Eur J Heart FailHome page
S. Stewart
Financial aspects of heart failure programs of care
Eur J Heart Fail, March 16, 2005; 7(3): 423 - 428.
[Abstract] [Full Text] [PDF]

Home page
 CMAJHome page
J. G.F. Cleland
Patients with treatable malignant diseases -- including heart failure -- are entitled to specialist care
Can. Med. Assoc. J., January 18, 2005; 172(2): 207 - 209.
[Full Text] [PDF]

Home page
 Eur J Heart FailHome page
R. J. Shelton, P. Velavan, N. P. Nikitin, A. P. Coletta, A. L. Clark, A. S. Rigby, N. Freemantle, and J. G.F. Cleland
Clinical trials update from the American Heart Association meeting: ACORN-CSD, primary care trial of chronic disease management, PEACE, CREATE, SHIELD, A-HeFT, GEMINI, vitamin E meta-analysis, ESCAPE, CARP, and SCD-HeFT cost-effectiveness study
Eur J Heart Fail, January 1, 2005; 7(1): 127 - 135.
[Abstract] [Full Text] [PDF]

Home page
 Eur Heart JHome page
J. S. Rumsfeld and F. A. Masoudi
Heart failure disease management works, but will it succeed?
Eur. Heart J., September 2, 2004; 25(18): 1565 - 1567.
[Full Text] [PDF]

This Article
Right arrow Abstract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Louis, A. A.
Right arrow Articles by Cleland, J. G.F.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Louis, A. A.
Right arrow Articles by Cleland, J. G.F.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?