Editoral : Correspondence regarding Anker SD, Koehler F, Abraham WT. Telemedicine and remote management of patients with heart failure. The Lancet 2011; 378: 731–39. Published 20 August 2011.
Inglis, Sally, Clark, Robyn, McAlister, Finlay A., Stewart, Simon, & Cleland, John GF Editoral : Correspondence regarding Anker SD, Koehler F, Abraham WT. Telemedicine and remote management of patients with heart failure. The Lancet 2011; 378: 731–39. Published 20 August 2011. (Unpublished)
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We read the excellent review of telemonitoring in chronic heart failure (CHF)1 with interest and commend the authors on the proposed classification of telemedical remote management systems according to the type of data transfer, decision ability and level of integration.
However, several points require clarification in relation to our Cochrane review of telemonitoring and structured telephone support2. We included a study by Kielblock3. We
corresponded directly with this study team specifically to find out whether or not this was a randomised study and were informed that it was a randomised trial, albeit by date of birth. We note in our review2 that this randomisation method carries a high risk of bias. Post-hoc metaanalyses without these data demonstrate no substantial change to the effect estimates for all cause mortality (original risk ratio (RR) 0·66 [95% CI 0·54, 0·81], p<0·0001; revised RR 0·72 [95% CI 0·57, 0·92], p=0·008), all-cause hospitalisation (original RR 0·91 [95% CI 0·84,
0·99] p=0·02; revised RR 0.92 [95% CI 0·84, 1·02], p=0·10 ) or CHF-related hospitalisation (original RR 0·79 [95% CI 0·67, 0·94] p=0·008; revised RR 0·75 [95% CI 0·60, 0·94] p=0·01).
Secondly, we would classify the Tele-HF study4, 5 as structured telephone support, rather than telemonitoring. Again, inclusion of these data alters the point-estimate but not the overall result of the meta-analyses4. Finally, our review2 does not include invasive telemonitoring as
the search strategy was not designed to capture these studies. Therefore direct comparison of our review findings with recent studies of these interventions is not recommended.
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|Additional Information:||Submitted to The Lancet in response to article published in: The Lancet 2011; 378: 731–39. Published 20 August 2011. Conflicts of interest Professor John Cleland has received funds from Philips and Bosch, which has have a commercial interest in telemonitoring, for research, staff and fees for consulting and has acted as a paid advisor on the subject of this correspondence.|
|Keywords:||Telemonitoring, heart failure, mortality|
|Divisions:||Current > QUT Faculties and Divisions > Faculty of Health|
Current > Schools > School of Nursing
|Copyright Owner:||Copyright 2011 Resides with the authors|
|Deposited On:||22 Nov 2011 12:05|
|Last Modified:||22 Nov 2011 14:23|
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