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Background: \ud \ud Specialised disease management programmes for heart failure aim to improve care, clinical outcomes and/or reduce healthcare utilisation. Since the last version of this review in 2010, several new trials of structured telephone support and non-invasive home telemonitoring have been published which have raised questions about their effectiveness.\ud Objectives: \ud \ud To review randomised controlled trials (RCTs) of structured telephone support or non-invasive home telemonitoring compared to standard practice for people with heart failure, in order to quantify the effects of these interventions over and above usual care.\ud Search methods: \ud \ud We updated the searches of the Cochrane Central Register of Controlled Trials (CENTRAL), Database of Abstracts of Reviews of Effects (DARE), Health Technology AsseFssment Database (HTA) on the Cochrane Library; MEDLINE (OVID), EMBASE (OVID), CINAHL (EBSCO), Science Citation Index Expanded (SCI-EXPANDED), Conference Proceedings Citation Index- Science (CPCI-S) on Web of Science (Thomson Reuters), AMED, Proquest Theses and Dissertations, IEEE Xplore and TROVE in January 2015. We handsearched bibliographies of relevant studies and systematic reviews and abstract conference proceedings. We applied no language limits.\ud Selection criteria: \ud \ud We included only peer-reviewed, published RCTs comparing structured telephone support or non-invasive home telemonitoring to usual care of people with chronic heart failure. The intervention or usual care could not include protocol-driven home visits or more intensive than usual (typically four to six weeks) clinic follow-up.\ud Data collection and analysis: \ud \ud We present data as risk ratios (RRs) with 95% confidence intervals (CIs). Primary outcomes included all-cause mortality, all-cause and heart failure-related hospitalisations, which we analysed using a fixed-effect model. Other outcomes included length of stay, health-related quality of life, heart failure knowledge and self care, acceptability and cost; we described and tabulated these. We performed meta-regression to assess homogeneity (the null hypothesis) in each subgroup analysis and to see if the effect of the intervention varied according to some quantitative variable (such as year of publication or median age).\ud Main results: \ud \ud We include 41 studies of either structured telephone support or non-invasive home telemonitoring for people with heart failure, of which 17 were new and 24 had been included in the previous Cochrane review. In the current review, 25 studies evaluated structured telephone support (eight new studies, plus one study previously included but classified as telemonitoring; total of 9332 participants), 18 evaluated telemonitoring (nine new studies; total of 3860 participants). Two of the included studies trialled both structured telephone support and telemonitoring compared to usual care, therefore 43 comparisons are evident.\ud \ud Non-invasive telemonitoring reduced all-cause mortality (RR 0.80, 95% CI 0.68 to 0.94; participants = 3740; studies = 17; I² = 24%, GRADE: moderate-quality evidence) and heart failure-related hospitalisations (RR 0.71, 95% CI 0.60 to 0.83; participants = 2148; studies = 8; I² = 20%, GRADE: moderate-quality evidence). Structured telephone support reduced all-cause mortality (RR 0.87, 95% CI 0.77 to 0.98; participants = 9222; studies = 22; I² = 0%, GRADE: moderate-quality evidence) and heart failure-related hospitalisations (RR 0.85, 95% CI 0.77 to 0.93; participants = 7030; studies = 16; I² = 27%, GRADE: moderate-quality evidence).\ud \ud Neither structured telephone support nor telemonitoring demonstrated effectiveness in reducing the risk of all-cause hospitalisations (structured telephone support: RR 0.95, 95% CI 0.90 to 1.00; participants = 7216; studies = 16; I² = 47%, GRADE: very low-quality evidence; non-invasive telemonitoring: RR 0.95, 95% CI 0.89 to 1.01; participants = 3332; studies = 13; I² = 71%, GRADE: very low-quality evidence).\ud \ud Seven structured telephone support studies reported length of stay, with one reporting a significant reduction in length of stay in hospital. Nine telemonitoring studies reported length of stay outcome, with one study reporting a significant reduction in the length of stay with the intervention. One telemonitoring study reported a large difference in the total number of hospitalisations for more than three days, but this was not an analysis of length of stay per hospitalisation. Nine of 11 structured telephone support studies and five of 11 telemonitoring studies reported significant improvements in health-related quality of life. Nine structured telephone support studies and six telemonitoring studies reported costs of the intervention or cost effectiveness. Three structured telephone support studies and one telemonitoring study reported a decrease in costs and two telemonitoring studies reported increases in cost, due both to the cost of the intervention and to increased medical management. Adherence was rated between 55.1% and 98.5% for those structured telephone support and telemonitoring studies which reported this outcome. Participant acceptance of the intervention was reported in the range of 76% to 97% for studies which evaluated this outcome. Seven of nine studies that measured these outcomes reported significant improvements in heart failure knowledge and self-care behaviours.\ud Authors' conclusions: \ud \ud For people with heart failure, structured telephone support and non-invasive home telemonitoring reduce the risk of all-cause mortality and heart failure-related hospitalisations; these interventions also demonstrated improvements in health-related quality of life and heart failure knowledge and self-care behaviours. Studies also demonstrated participant satisfaction with the majority of the interventions which assessed this outcome.

Background Home Telemonitoring may improve the management of patients with heart failure, reducing morbidity and mortality. Consequently, there is a growing interest in the use of non-invasive devices for remote monitoring of cardiovascular function. The physiological impact of environmental factors such as temperature on haemodynamic recordings in patients with heart failure has not been explored. Design and methods Patients with a clinical diagnosis of heart failure, receiving loop diuretics and with objective evidence of cardiac dysfunction were enrolled. A control group without heart failure was also enrolled. Continuous beat-to-beat pulse contour analysis was undertaken using finger-tip, volume-clamp (Nexfin, Bmeye, Netherlands) to measure haemodynamics on separate days at cool (19°C) and warm (28°C) room temperatures in the supine position and during light exercise. Results Haemodynamic data were obtained from a total of 12 men with stable heart failure (HF) aged between 46 and 90 years (mean, 72±13 years) and 6 patients (5 men and 1 woman) with hypertension (HTN) aged between 51 and 75 years (mean, 67±9 years). Mean LVEF was 32±12% while the median NT-proBNP was 1207 (IQR 431–3506) pg/ml in the HF cohort. Mean LVEF was 57±5% while median NT-proBNP was103 (IQR 48–178) pg/ml in the HTN group. Measurements at higher ambient temperatures induced vasodilation with a fall in BP and a rise in CI. Conclusions Changes in environmental temperature have marked effects on haemodynamics which can be detected non-invasively with telemonitoring devices. Local environmental conditions should be taken into account as they may be important for interpretation of data. Control of environmental temperature should be explored as a potential adjunct to therapy in patients with heart failure. Longer term studies are required to assess effects on fluid balance.

Background Amongst patients with heart failure (HF) due to left ventricular systolic dysfunction (LVSD) in sinus rhythm, those with higher resting heart rate (HR) have a worse prognosis. Reducing sinus rate to 50–60 bpm improves outcomes. If beta blockers (BB) are not tolerated or HR remains >70 bpm despite BB, ivabradine may reduce HR and improve outcome. Aims To characterise patients attending a HF clinic and identify the proportion eligible for optimisation of BB or ivabradine treatment. The clinic accepts referrals from primary and secondary care and offers long term follow-up regardlesss of LVEF. Methods and Results Between January 2013 and July 2013, 1000 consecutive HF clinic follow-up appointments were reviewed and demographic, clinical and echocardiographic data were collected in patients who attended (n = 959, 644 male). The median duration between initial assessment and follow-up was 941 (IQR 347–2153) days. Most patients had mild to moderate HF (25% NYHA I, 51% NYHA II and 24% NYHA III/IV). Median agewas 76 (IQR 68–82) years,NTproBNP 1091 ng/L (IQR 396–2230) and ejection fraction (EF) 45 (IQR 36–54)%, with 370 patients (39%) having a reduced EF ( In those with LVSD, sinus rhythm and a HR above 70 bpm (n = 90), 18 patients were already treated with guideline-target doses of BB, 24 had BB dose increased, 19 were known to be intolerant of higher dose and 26 were eligible for uptitration of BB but did not receive appropriate advice (‘missed indication’). Thirty seven patients who were receiving maximally tolerated BB doses or were BB intolerant, were eligible for ivabradine. Seven patients were already taking ivabradine at the time of assessment and in 5 of these the dose was increased, 13 were started on treatment following the clinic visit, and in 17 patients, the indication was initially ‘missed’. Conclusion Among patients with LVSD (about 37% of those with HF), most are treated with a BB at a dose that maintains HR