Complex telemonitoring or a simple telephone call: which is more effective in post-discharge heart failure (HF) management?

In an era of rapidly advancing access to information technology trials of new technologies are continually emerging. The aim of this study was to compare the effect of specific technology on efficacy in post-discharge HF management. Methods Peer reviewed randomised controlled trials were meta-analysed using Revman Software. Analyses were performed according using intention-to-treat and Mantel-Haenzel fixed effects methods Risk ratios and 95% confidence intervals were calculated for all-cause mortality, hospitalization and HF-related hospitalization. Results 16 comparisons of structured telephone support (STS= 5,613 participants), 11 telemonitoring (TM=2,710 participants) and 2 studies of both were reviewed. The STS studies had the most homogenous use of technology with 15 reporting the use of simple telephone calls to retrieve data from patients and 1 study which compared STS to videophone follow-up. The telemonitoring group described various technologies to transfer data (Satellite, Broadband, and Interactive Voice Response-IVR). A highly significant effect on risk reduction for all cause mortality was seen in those patients who received complex telemonitoring [RR 0.63 (95% CI, 0.51, 0.77) P<0.00001]. Simple telephone calls [RR 0.77 (955 CI, 0.68, 0.87) p<0.0001] and Complex Telemonitoring [RR 0.78 (95% CI, 0.66, 0.93) p=0.006] were effective in reducing the risk of HF-related readmissions. Videophone and IVR had the least impact on outcomes.