Telemonitoring in heart failure: A state‐of‐the‐art review

Sousa, Carla; Leite, Sérgio; Lagido, R. B.; Ferreira, Liliana; Silva‐Cardoso, J.; Maciel, Maria Júlia

doi:10.1016/j.repce.2013.10.041

Cited by 4 publications

(11 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This vast, complex and statistically daunting literature has been summarised and critiqued in detail elsewhere [5–7, 21, 33, 38, 39, 55, 64, 65, 68, 70]. In this section, we summarise key points from published reviews and consider the question of why so many trials and secondary analyses have produced so few clear recommendations for practice and policy.…”

Section: Resultsmentioning

confidence: 99%

“…Implantable defibrillators, which do not affect underlying ventricular function, and atrioventricular synchronised biventricular pacemakers (also referred to as cardiac resynchronisation therapy), which do, have both been shown to improve survival in people with moderate to severe chronic heart failure, though the benefit-harm balance of such interventions in less severe heart failure is less clear [ 65 , 70 ]. Updated guidelines for cardiac resynchronisation therapy advise confining its use to HFREF patients with ejection fraction below 35% [ 81 ].…”

Section: Resultsmentioning

confidence: 99%

“…TG began with a generic PubMed search for ‘heart failure’ and ‘telehealth’, including synonyms for both. She quickly identified a sample of highly-cited review articles covering both quantitative and qualitative research [ 5 , 7 , 17 , 21 , 38 , 52 , 65 , 68 – 70 ]. She used citation tracking in Google Scholar to identify subsequent articles that had cited these seminal sources [ 71 ].…”

Section: Methodsmentioning

confidence: 99%

“…Systematic reviews and meta-analyses have been criticised for major methodological flaws [6, 33, 36, 38, 39, 64, 65] and economic evaluations for their questionable and/or unstated assumptions [42]. The service and regulatory context is under-researched.…”

Section: Introductionmentioning

confidence: 99%

“…In the context of high and rising prevalence of heart failure [ 52 – 54 ] and its unenviable position atop the league table of reasons for hospital readmission [ 55 ], recruitment of heart failure patients to clinical trials of telehealth is consistently poor [ 17 , 32 , 56 – 58 ]; roll-out and scale-up of telehealth services for heart failure in real-world settings is slow [ 32 , 49 , 59 – 63 ]; and robust business models are lacking [ 5 ]. Systematic reviews and meta-analyses have been criticised for major methodological flaws [ 6 , 33 , 36 , 38 , 39 , 64 , 65 ] and economic evaluations for their questionable and/or unstated assumptions [ 42 ]. The service and regulatory context is under-researched.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Understanding heart failure; explaining telehealth – a hermeneutic systematic review

Greenhalgh

A’Court

Shaw

2017

BMC Cardiovasc Disord

127

222

View full text Add to dashboard Cite

BackgroundEnthusiasts for telehealth extol its potential for supporting heart failure management. But randomised trials have been slow to recruit and produced conflicting findings; real-world roll-out has been slow. We sought to inform policy by making sense of a complex literature on heart failure and its remote management.MethodsThrough database searching and citation tracking, we identified 7 systematic reviews of systematic reviews, 32 systematic reviews (including 17 meta-analyses and 8 qualitative reviews); six mega-trials and over 60 additional relevant empirical studies and commentaries. We synthesised these using Boell’s hermeneutic methodology for systematic review, which emphasises the quest for understanding.ResultsHeart failure is a complex and serious condition with frequent co-morbidity and diverse manifestations including severe tiredness. Patients are often frightened, bewildered, socially isolated and variably able to self-manage. Remote monitoring technologies are many and varied; they create new forms of knowledge and new possibilities for care but require fundamental changes to clinical roles and service models and place substantial burdens on patients, carers and staff. The policy innovation of remote biomarker monitoring enabling timely adjustment of medication, mediated by “activated” patients, is based on a modernist vision of efficient, rational, technology-mediated and guideline-driven (“cold”) care. It contrasts with relationship-based (“warm”) care valued by some clinicians and by patients who are older, sicker and less technically savvy. Limited uptake of telehealth can be analysed in terms of key tensions: between tidy, “textbook” heart failure and the reality of multiple comorbidities; between basic and intensive telehealth; between activated, well-supported patients and vulnerable, unsupported ones; between “cold” and “warm” telehealth; and between fixed and agile care programmes.ConclusionThe limited adoption of telehealth for heart failure has complex clinical, professional and institutional causes, which are unlikely to be elucidated by adding more randomised trials of technology-on versus technology-off to an already-crowded literature. An alternative approach is proposed, based on naturalistic study designs, application of social and organisational theory, and co-design of new service models based on socio-technical principles. Conventional systematic reviews (whose goal is synthesising data) can be usefully supplemented by hermeneutic reviews (whose goal is deepening understanding).Electronic supplementary materialThe online version of this article (doi:10.1186/s12872-017-0594-2) contains supplementary material, which is available to authorized users.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Understanding heart failure; explaining telehealth – a hermeneutic systematic review

Greenhalgh

A’Court

Shaw

2017

BMC Cardiovasc Disord

127

222

View full text Add to dashboard Cite

show abstract

e-Health and Co-production: Critical Drivers for Chronic Diseases Management

Palozzi

Binci

Appolloni

2016

Service Business Model Innovation in Healthcare and Hospital Management

View full text Add to dashboard Cite

Mining telemonitored physiological data and patient-reported outcomes of congestive heart failure patients

et al. 2018

View full text Add to dashboard Cite

This paper addresses patient-reported outcomes (PROs) and telemonitoring in congestive heart failure (CHF), both increasingly important topics. The interest in CHF trials is shifting from hard end-points such as hospitalization and mortality, to softer end-points such health-related quality of life. However, the relation of these softer end-points to objective parameters is not well studied. Telemonitoring is suitable for collecting both patient-reported outcomes and objective parameters. Most telemonitoring studies, however, do not take full advantage of the available sensor technology and intelligent data analysis. The Chiron clinical observational study was performed among 24 CHF patients (17 men and 7 women, age 62.9 ± 9.4 years, 15 NYHA class II and 9 class III, 10 of ishaemic, aetiology, 6 dilated, 2 valvular, and 6 of multiple aetiologies or cardiomyopathy) in Italy and UK. A large number of physiological and ambient parameters were collected by wearable and other devices, together with PROs describing how well the patients felt, over 1,086 days of observation. The resulting data were mined for relations between the objective parameters and the PROs. The objective parameters (humidity, ambient temperature, blood pressure, SpO2, and sweeting intensity) could predict the PROs with accuracies up to 86% and AUC up to 0.83, making this the first report providing evidence for ambient and physiological parameters to be objectively related to PROs in CHF patients. We also analyzed the relations in the predictive models, gaining some insights into what affects the feeling of health, which was also generally not attempted in previous investigations. The paper strongly points to the possibility of using PROs as primary end-points in future trials.

show abstract

Telemonitoring in heart failure: A state‐of‐the‐art review

Cited by 4 publications

References 26 publications

Understanding heart failure; explaining telehealth – a hermeneutic systematic review

Understanding heart failure; explaining telehealth – a hermeneutic systematic review

e-Health and Co-production: Critical Drivers for Chronic Diseases Management

Mining telemonitored physiological data and patient-reported outcomes of congestive heart failure patients

Contact Info

Product

Resources

About