Phone support cuts heart failure deaths
GPs can help reduce rates of heart failure hospitalisation or mortality by providing their patients with structured telephone support, a new systematic review concludes.
A meta-analysis of 14 trials involving 4,264 patients found remote monitoring schemes
reduced the rates of admission to hospital for chronic heart failure by 21 per cent, and all-cause mortality by 20 per cent.
Three trials also reported significant improvements in quality of life in patients provided with remote monitoring. Four trials examining the costs of telephone support found a reduction or no increase.
The researchers, from the UK, Australia and Canada, concluded self-care programmes that include remote monitoring and telephone support 'have a positive effect
on clinical outcomes in
patients with heart failure'.
But they cautioned telemonitoring was likely to produce 'false alarms and pre-emptive admissions' in patients deteriorating but not yet in crisis. And they warned that it could lead to early discharge by secondary care professionals falsely comforted by the high level of monitoring at home.
Study leader Professor
Simon Stewart, head of the
preventive cardiology unit at the Baker heart research institute in Melbourne, Australia, said: 'Although we have shown substantial and statistically significant benefits with remote monitoring for patients with chronic heart failure, monitoring is not a treatment but a different way of systematically organising effective care.'
Writing in the latest issue
of the BMJ, he added: 'Programmes that include remote monitoring should not be seen as a replacement for specialist care but may be of particular benefit to those with difficulty accessing specialised care.'
Dr Ian Johnstone, a GP in Musselburgh, east Lothian, and a member of the Lothian heart failure network, said a programme with telephone monitoring for chronic heart failure patients in his practice worked well and reduced admissions.
He said: 'You can certainly do more management by telephone than by home visiting. It has lots of potential to free up GP and nurse time and improve patient management.'
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Remote monitoring: the facts
• Remote telemonitoring has potential to improve clinical outcomes in patients living in
• Monitoring has been shown
to reduce hospital admissions
and all-cause mortality
• Likely to be particular benefits for patients in remote areas
• Telemonitoring should not replace specialist care or heart failure clinics