Home telemonitoring, natriuretic peptide guided therapy and formal follow up by a heart failure team

Research recommendation/question:
What is the effectiveness and cost effectiveness of home telemonitoring, monitoring of serum natriuretic peptides and formal follow-up by a heart failure team for patients with heart failure due to left ventricular systolic dysfunction?
PopulationInterventionComparisonOutcomes
Heart failure due to LVSDTelemonitoring
Or BNP
Clinical careMortality (all cause, heart failure)
Hospitalisation (heart failure, all cause, planned, unplanned)
Change in NYHA class
Patient/carer acceptability
Quality of life
Adverse events
Why this is important:
Heart failure is characterised by repeated hospitalisation. For people with systolic left ventricular dysfunction hospitalisation can be reduced by appropriate treatment and organised nursing care. Recent studies of ways to prevent hospitalisation have focused on telemonitoring (the patient’s status is assessed in the patient’s own home) and the use of serum natriuretic peptide levels (to guide uptitration of drugs) compared with “usual” care. The studies used various research methods and differing levels of “usual care”, which makes it difficult to compare the results. It has been suggested that, when care is delivered by an organised heart failure team under consultant supervision, then additional strategies such as telemonitoring and monitoring of serum natriuretic peptides may not confer advantage. Further research is important to ascertain whether monitoring and supervision techniques afford advantage over formal, organised care by a specialist multidisciplinary heart failure team.

From: 9, Research recommendations

Cover of Chronic Heart Failure
Chronic Heart Failure: National Clinical Guideline for Diagnosis and Management in Primary and Secondary Care: Partial Update [Internet].
NICE Clinical Guidelines, No. 108.
National Clinical Guideline Centre (UK).
Copyright © 2010, National Clinical Guideline Centre.

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