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Remote health monitoring
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| Konstam et al.(1212 Konstam V, Gregory D, Chen J, Weintraub A, Patel A, Levine D, et al. Health-related quality of life in a multicenter randomized controlled comparison of telephonic disease management and automated home monitoring in patients recently hospitalized with heart failure: SPAN-CHF II trial. J Card Fail. 2011;17(2):151-7.), 2011USARandomized clinical trialJournal of Cardiac Failure |
To compare the program Primary Specialized Care and Care Network of people with HF with and without automated home monitoring. |
CG: Monitoring through weekly telephone calls. Patients had continuous access to a database with information on their records, medication and laboratory data (n=44).IG: Monitoring through a system that provided information on weight, vital signs, transmission of text messages with information on symptoms and functional status. The device was programmed to provide daily analysis of all medication doses (n=44).Instrument: MLHFQMonitoring was performed by nurses. |
There was no difference in QoL between groups after 45 days (p=0.416) and 90 days (p=0.759). |
Domingo et al.(1313 Domingo M, Lupón J, González B, Crespo E, López R, Ramos A, et al. Noninvasive remote telemonitoring for ambulatory patients with heart failure: effect on number of hospitalizations, days in hospital, and quality of life. CARME (Catalan Remote Management Evaluation) study. Rev Esp Cardiol [Internet]. 2011[cited 2016 Jan 10];64(4):277-85. Available from: http://www.revespcardiol.org/en/noninvasive-remote-telemonitoring-for-ambulatory/articulo/90002056/.
http://www.revespcardiol.org/en/noninvas...
), 2011SpainRandomized clinical trialSpanish Cardiology Magazine |
To assess the impact of a telemedicine program on patients of a multidisciplinary HF unit. |
CG: Interactive platform that broadcasts patient data from their homes to the hospital unit through the Internet (n=44).IG: Interactive platform, another tool for self-monitoring weight, arterial pressure and cardiac frequency, inserted every morning before breakfast (n=48).Instrument: EQ-5D and MLHFQAuthors did not mention which professionals monitored the training. |
There was a difference in QoL between groups as measured by EQ-5D (p=0.165) or by MLHFQ (p=0.690) after 12 months. |
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Remote health monitoring
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Cartwright et al.(1414 Cartwright M, Hirani SP, Rixon L, Beynon M, Doll H, Bower P, et al. Effect of telehealth on quality of life and psychological outcomes over 12 months (Whole Systems Demonstrator telehealth questionnaire study): nested study of patient reported outcomes in a pragmatic, cluster randomized controlled trial. BMJ [Internet]. 2013[cited 2016 Jan 10];346:f653. Available from: http://www.bmj.com/content/bmj/346/bmj.f653.full.pdf
http://www.bmj.com/content/bmj/346/bmj.f...
), 2013United KingdomRandomized clinical trialBritish Medical Journal |
To assess the effects of home telehealth on QoL, anxiety and depressive symptoms over 12 months in chronic patients. |
CG: Care plan with predefined home visits according to severity (n=728).IG: Tele transmission of vital signs and symptoms. Patients could also get in touch with center office by phone. They received health education information from health centers (n=845).Instrument: SF-36 and EQ-5DMonitoring was performed by nurses. |
There was no difference in QoL between groups (p=0.807) after 12 months. |
Gellis et al.(1515 Gellis ZD, Kenaley B, McGinty J, Bardelli E, Davitt J, Ten Have T. Outcomes of a telehealth intervention for homebound older adults with heart or chronic respiratory failure: a randomized controlled trial. Gerontologist [Internet]. 2012[cited 2016 Jan 10];52(4):541-52. Available from: http://gerontologist.oxfordjournals.org/content/52/4/541.long
http://gerontologist.oxfordjournals.org/...
), 2012USARandomized clinical trialGerontologist |
To assess the impact of telehealth intervention on general and mental health of homebound elderly patients with HF or chronic obstructive pulmonary disease. |
CG: Weekly home service (n=58)IG: Daily monitoring of weight and vital signs, instructions on health education and telephone access to a nurse for clearing doubts related to treatment (n=57).Instrument: (SF-36)Monitoring was performed by nurses. |
There was significant QoL improvement in IG in general health status (p=0.016) and social functioning (p<0.014) after three and 12 months. |
Landolina et al.(1616 Landolina M, Perego GB, Lunati M, Curnis A, Guenzati G, Vicentini A, et al. Remote monitoring reduces healthcare use and improves quality of care in heart failure patients with implantable defibrillators: the evolution of management strategies of heart failure patients with implantable defibrillators (EVOLVO) study. Circulation [Internet]. 2012[cited 2016 Jan 10];125(24):2985-92. Available from: http://circ.ahajournals.org/content/125/24/2985.long
http://circ.ahajournals.org/content/125/...
), 2012ItalyRandomized clinical trialCirculation |
To determine whether remote monitoring can lower the number of HF and ICD cases in emergency services. |
CG: No ICD data transmission to physician in charge (n=101).IG: Remote home monitoring. ICD data transmitted to a center that reported changes to physician in charge (n=99).Instrument: MLHFQIntervention was performed by physicians. |
Significant QoL improvement in IG after 16 months (p=0.026). |
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Instructions on health practices
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Baker et al.(1717 Baker DW, Dewalt DA, Schillinger D, Hawk V, Ruo B, Bibbins-Domingo K, et al. The effect of progressive, reinforcing telephone education and counseling versus brief educational intervention on knowledge, self-care behaviors and heart failure symptoms. J Card Fail [Internet]. 2011[cited 2016 Jan 10];17(10):789-96. Available from: http://www.onlinejcf.com/article/S1071-9164(11)00628-2/abstract
http://www.onlinejcf.com/article/S1071-9...
), 2011USARandomized clinical trialJournal of Cardiac Failure |
To assess the effects of two different training levels for adoption of self-care and quality of life behaviors for people with HF. |
CG: Single session for education and routine care (n=302).IG: Intensive training for self-care employing daily weight measurements to guide diuretic self-adjustment, including an individualized plan. Over the following four weeks, patients received five to eight phone calls from the educator to reinforce education and give instructions on self-care skills. The two first calls focused on self-monitoring and self-management of weight. Later calls focused on self-maintenance, including adherence to medication, limitation of sodium intake and exercise (n=303).Instrument: MLHFQIntervention was performed by physicians. |
There was significant QoL improvement in IG after four weeks (p<0.001). |
Ekman et al.(1818 Ekman I, Wolf A, Olsson LE, Taft C, Dudas K, Schaufelberger M, et al. Effects of person-centred care in patients with chronic heart failure: the PCC-HF study. Eur Heart J [Internet]. 2012[cited 2016 Jan 10];33:1112-9. Available from: http://eurheartj.oxfordjournals.org/content/early/2011/09/15/eurheartj.ehr306
http://eurheartj.oxfordjournals.org/cont...
), 2012SwedenRandomized clinical trialEuropean Heart Journal |
To assess whether person-centered care reduces hospitalization length, improves activities of daily living and impacts QoL and rehospitalization. |
CG: Routine care (n=123)IG: Person-centered care, planned based on careful clinical and social assessments at admission, including planned investigations, treatment objectives and length of hospitalization. The plan was then readjusted with the patient and finalized in 48 to 72 hours. During the plan’s performance, patients self-assessed their symptoms through a Likert scale. Additional or new information was checked 72 hours after admission and every 48 hours to assess and adjust the plan (n=125).Instrument: KCCQIntervention was performed by nurses, physicians, physical therapists and occupational therapists. |
There was no difference in QoL between groups (p=0.60) after three months. |
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Instructions on health practices
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Wang et al.(1919 Wang SP, Lin LC, Lee CM, Wu SC. Effectiveness of a self-care program in improving symptom distress and quality of life in congestive heart failure patients: a preliminary study. J Nurs Res [Internet]. 2011[cited 2016 Jan 10];19(4):257-66. Available from: https://www.ncbi.nlm.nih.gov/pubmed/22089651
https://www.ncbi.nlm.nih.gov/pubmed/2208...
), 2011TaiwanRandomized clinical trialJournal of Nursing Research |
To explore the effects of a self-care program for elderly persons with symptomatic HF in terms of: functional state, QoL, emergency visits and rehospitalizations three months after hospital discharge. |
CG: Routine care during hospitalization (n=13)IG: Daily visits during hospitalization for symptom assessment and patient education. Before discharge, an informal meeting was conducted with families to remind them of medication and date of next clinical follow-up. The first phone call was made three or four days after discharge. During home visits, not only HF signs and symptoms were assessed, but also how they implemented self-care skills in their daily routines (n=14)Instrument: (SF-36)Monitoring was performed by nurses. |
There was significant QoL improvement in IG after three months (p<0.05). |
Dekker et al.(2020 Dekker RL, Moser DK, Peden AR, Lennie TA. Cognitive therapy improves three-month outcomes in hospitalized patients with heart failure. J Card Fail [Internet]. 2012[cited 2016 Jan 10];18(1):10-20. Available from: http://www.onlinejcf.com/article/S1071-9164(11)01194-8/abstract
http://www.onlinejcf.com/article/S1071-9...
), 2012USARandomized clinical trialJournal of Cardiac Failure |
To test short-term effects of a brief cognitive therapy intervention for patients hospitalized with HF who presented depressive symptoms. |
CG: HF instructions and brief written information on emotional aspects of living with HF (n=21).IG: A cognitive therapy session during hospitalization, a propelling phone call and a brochure with the intervention’s content for taking home (n=21).Instrument: MLHFQIntervention was performed by nurses. |
There was no difference in QoL between groups (p=0.45) one week after discharge and after three months. |
Alves et al.(2121 Alves FD, Souza GC, Brunetto S, Perry IDS, Biolo A. Nutritional orientation, knowledge and quality of diet in heart failure: randomized clinical trial. Nutr Hosp [Internet]. 2012[cited 2016 Jan 10];27(2): 441-8. Available from: https://www.ncbi.nlm.nih.gov/pubmed/22732966
https://www.ncbi.nlm.nih.gov/pubmed/2273...
), 2012BrazilRandomized clinical trialHospital nutrition |
To assess whether nutritional instructions improve adherence to diet guidelines (sodium restriction and diet quality), nutritional knowledge, anthropometric measures and QoL in people with HF. |
CG: Assessment of anthropometric data (n=23)IG: Assessment of anthropometric data and nutritional instructions and their link to HF. A calendar, created for the intervention, was handed out as educational strategy. Goals were set to improve diet adherence and motivation. After one month, the strategy was intensified whenever inadequate behaviors were detected (n=23).Instrument: MLHFQAssessment and instructions were performed by a nutritional therapist. |
There was no difference in QoL between groups (p=0.736) after six weeks and six months. |
Angermann et al.(2222 Angermann CE, Störk S, Gelbrich G, Faller H, Jahns R, Frantz S. Mode of action and effects of standardized collaborative disease management on mortality and morbidity in patients with systolic heart failure: the Interdisciplinary Network for Heart Failure (INH) study. Circ Heart Fail [Internet]. 2012[cited 2016 Jan 10];5(1):25-35. Available from: http://circheartfailure.ahajournals.org/content/5/1/25.long
http://circheartfailure.ahajournals.org/...
), 2012GermanyRandomized clinical trialCirculation Heart Failure |
To compare the impact of routine care with the software HeartNetCare in relation to time until death or rehospitalization of HF patient. |
CG: Routine care: standard planning post-discharge, which includes treatment plans and appointments with a cardiologist between 7 and 14 days (n=363).IG: Presence during hospitalization, with practical supervision of measurements of arterial pressure, heart frequency and symptoms, distribution of educational resources on self-monitoring; telephone monitoring, with a questionnaire on signs of worsening HF, other symptoms, medication, use of health services, mood and general health status and well-being; explanation and names of medication; necessary adjustments to specialized care administered by a nurse (n=352).Instrument: SF-36The program was coordinated by nurses and involved general physicians and cardiologists. |
There was significant improvement in IG in the components physical health (p=0.03) and physical functioning (p=0.03) of SF-36 after 180 days. |
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Physical activity follow-up
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Pihl et al.(2323 Pihl E, Cider A, Stromberg A, Fridlund B, Martensson J. Exercise in elderly patients with chronic heart failure in primary care: effects on physical capacity and health-related quality of life. Eur J Cardiovasc Nurs [Internet]. 2011[cited 2016 Jan 10];10(3):150-8. Available from: http://cnu.sagepub.com/content/10/3/150.long
http://cnu.sagepub.com/content/10/3/150....
), 2011SwedenRandomized clinical trialEuropean Journal of Cardiovascular Nursing |
To determine the effects on physical capacity and QoL of an exercise program in elderly patients with chronic HF receiving primary care. |
CG: Routine care without exercise (n=31)IG: Aerobic and muscle exercise at home for 12 months, adapted to patients’ physical capacity (n=28).During the first six months, patients exercised once a week with a group in the primary care center and three times a week at home. During the final six months, they exercised three times a week at home and once a month in the basic care center.Instrument: MLHFQ, SF-36, EQ-5DExercises were guided by a physical therapist. |
There was significant improvement in the general health (p=0.048) and physical components (p=0.026) of SF-36 after three months; physical dimension of MLHFQ (p=0.008) after three months; and EQ-5D after three months (p=0.016) and after 12 months (p=0.034) |
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Physical activity follow-up
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Pozehl et al.(2424 Pozehl B, Duncan K, Hertzog M, Norman JF. Heart failure exercise and training camp: effects of a multicomponent exercise training intervention in patients with heart failure. Heart Lung [Internet]. 2010[cited 2016 Jan 10];39(6 Suppl):S1-13. Available from: http://www.heartandlung.org/article/S0147-9563(10)00136-6/abstract
http://www.heartandlung.org/article/S014...
), 2010USARandomized clinical trialHeart & Lung |
To determine differences in self-efficacy for exercise in IG when compared to CG and determine differences in symptoms. |
CG: Educational sessions with topics relevant to HF (n=20).IG: Structured aerobic exercise and resistance training + group meetings and educational sessions with themes addressing HF (n=22).Instrument: KCCQExercises were guided by a physical therapist and a nurse. |
There was significant improvement in both groups, with statistically higher increase in IG (p<0.01) after 12 weeks. |
Kitzman et al.(2525 Kitzman DW, Brubaker PH, Morgan TM, Stewart KP, Little WC. Exercise training in older patients with heart failure and preserved ejection fraction: a randomized, controlled, single-blind trial. Circ Heart Fail [Internet]. 2010[cited 2016 Jan 10];3(6):659-67. Available from: http://circheartfailure.ahajournals.org/content/3/6/659.long
http://circheartfailure.ahajournals.org/...
), 2010USARandomized clinical trialCirculation Heart Failure |
To test the hypothesis that supervised physical training improves peak O2 consumption and QoL for elderly individuals with HF and who have preserved left ventricular ejection fraction. |
CG: Instructions passed through telephone calls every two weeks, over 16 weeks (n=27)IG: Aerobic exercise three times a week for 16 weeks, in a total of 48 sessions at a specific location (n=26).Instrument: MLHFQ and SF-36Training was monitored by physicians. |
Improvement happened only on MLHFQ’s physical subscale (p=0.03) and there was no significant difference in SF-36. |
Bocalini et al.(2626 Bocalini DS, dos Santos L, Serra AJ. Physical exercise improves the functional capacity and quality of life in patients with heart failure. Clinics [Internet]. 2008[cited 2016 Jan 10];63(4):437-42. Available from: http://www.scielo.br/pdf/clin/v63n4/a05v63n4.pdf
http://www.scielo.br/pdf/clin/v63n4/a05v...
), 2008BrazilRandomized clinical trialClinics (São Paulo) |
To assess whether guided and monitored physical exercises can be considered safe for patients with HF, and whether exercise can benefit functional capacity, based on activities of daily living, autonomy and QoL. |
CG: Routine care (n=20)IG: Aerobic and muscle exercises three times a week over six months, with individually controlled intensity (n=22).Instrument: WHOQOL-BREFAuthors did not mention which professionals monitored the training. |
There was significant improvement in intervention group across a number of WHOQOL-BREF domains (p<0.001) after six months. |
Fayazi et al.(2727 Fayazi S, Zarea K, Abbasi A, Ahmadi F. Effect of home-based walking on performance and quality of life in patients with heart failure. Scand J Caring Sci [Internet]. 2013[cited 2016 Jan 10];27(2):246-52. Available from: http://onlinelibrary.wiley.com/doi/10.1111/j.1471-6712.2012.01020.x/epdf
http://onlinelibrary.wiley.com/doi/10.11...
), 2013IranNonrandomized clinical trialScandinavian Journal of Caring Sciences |
To assess the effect of a home walking program on performance and QoL of patients with HF. |
CG: No intervention (n=30)IG: Instructions about walking for 30 minutes three times per week over eight weeks + information on how to exercise safely and properly, including self-monitoring for symptoms, stress level and exercise-related problems, explained and summarized in a brochure + daily telephone calls to monitor adherence, progress, doubt clearing, and individualized feedback (n=30)Instrument: MLHFQAuthors did not mention which professionals monitored the training. |
There was significant QoL improvement in IG (p<0.001) after eight weeks. |
Smart & Murison(2828 Smart NA, Murison R. Rate of change in physical fitness and quality of life and depression following exercise training in patients with congestive heart failure. Congest Heart Fail [Internet]. 2013[cited 2016 Jan 10];19(1):1-5. Available from: http://onlinelibrary.wiley.com/doi/10.1111/chf.12002/epdf
http://onlinelibrary.wiley.com/doi/10.11...
), 2013AustraliaQuasi-experimental studyCongestive Heart Failure |
To identify changes in exercise basal rate, in QoL and in depression after physical training for patients with congestive heart failure. |
IG: Sixteen weeks of physical training in bicycle ergometer three times per week + series of five muscle strength exercises from the 8th until the 16th week, adapted to each patient (n=30).Instrument: MLHFQAuthors did not mention which professionals monitored the training. |
There was significant QoL improvement after 16 and 52 weeks (p<0.001). |
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Physical activity follow-up
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| Smart & Steele(2929 Smart NA, Steele M. A comparison of 16 weeks of continuous vs intermittent exercise training in chronic heart failure patients. Congest Heart Fail. 2012;18(4):205-11.), 2012AustraliaRandomized clinical trialCongestive Heart Failure |
To determine whether intermittent physical training produces similar results to a continuous training program for people with chronic HF. |
CG: Intermittent physical training (16 weeks of bicycle ergometer three times per week for 60 minutes, with 60 seconds of work and 60 seconds of rest) (n=10).IG: Continuous physical training (16 weeks of bicycle ergometer three times per week for 30 minutes, continually) (n=13).Instrument: MLHFQ and SF-36Authors did not mention which professionals monitored the training. |
CG obtained improvement on emotional role subscale of SF-36 (p=0.05) and did not obtain improvements in MLHFQ (p=0.11). IG obtained improvement in vitality subscale of SF-36 (p=0.03) and in MLHFQ (p=0.02) after 16 weeks. |
| Belardinelli et al.(3030 Belardinelli R, Georgiou D, Cianci G, Purcaro A. 10-year exercise training in chronic heart failure: a randomized controlled trial. J Am Coll Cardiol. 2012;60(16):1521-8.), 2012ItalyRandomized clinical trialJournal of the American College of Cardiology |
To determine whether moderate physical training program monitored over ten years improves functional capacity and QoL of patients with HF in functional classes II and III. |
CG: Activities of daily living, avoiding exercises monitored by professionals. Subjects were instructed on nutrition, stress decrease, quitting smoking and physical training. They consulted cardiologist every three months (n=60).IG: Aerobic activity sessions in bicycle ergometer and/or treadmill (three weekly sessions over two months, followed by two yearly sessions, over 10 years) (n=63).Instrument: MLHFQActivities were managed by a physical therapist and a cardiologist physician. |
IG presented significant improvement in QoL score (p<0.05) after ten years. |
Witham et al.(3131 Witham MD, Fulton RL, Greig CA, Johnston DW, Lang CC, Boyers D, et al. Efficacy and cost of an exercise program for functionally impaired older patients with heart failure: a randomized controlled trial. Circ Heart Fail [Internet]. 2012[cited 2016 Jan 10];5(2):209-16. Available from: http://circheartfailure.ahajournals.org/content/circhf/5/2/209.full.pdf
http://circheartfailure.ahajournals.org/...
), 2012United KingdomRandomized clinical trialCirculation Heart Failure |
To test the efficacy of a more intense physical program aimed at elderly patients functionally compromised by HF. |
CG: Brochures with instructions on diet, exercise and lifestyle (n=54)IG: Gymnastics class twice per week over eight weeks. After eight weeks, 16 weeks of exercise were performed at patients’ homes + educational brochures on benefits of exercise, goals and how to work toward them, relaxation techniques, information on how thoughts and feelings affect symptoms and how to handle difficulties (n=53).Instrument: MLHFQ and EQ-5DGymnastics classes were monitored by a physical therapist. |
There were no significant differences between groups (p=0.42 in EQ5D and p=0.12 in MLHFQ) after 24 weeks. |
Howie-Esquivel et al.(3232 Howie-Esquivel J, Lee J, Collier G, Mehling W, Fleischmann K. Yoga in heart failure patients: a pilot study. J Card Fail [Internet]. 2010[cited 2016 Jan 10];16(9):742-9. Available from: https://www.omicsonline.org/references/yoga-in-heart-failure-patients-a-pilot-study-82195.html
https://www.omicsonline.org/references/y...
), 2010USAQuasi-experimental studyJournal of Cardiac Failure |
To determine whether an eight-week yoga program is safe and can positively influence physical and psychological functioning of patients with HF. |
IG: Two weekly 60-minute yoga classes over eight weeks. Participants were also instructed to practice breathing exercises at home for 15 minutes three times per week (n=12)Instrument: KCCQYoga sessions were conducted by two nurses. |
There was improvement in symptom stability subscale of KCCQ instrument (p=0.02) after eight weeks. |
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Traditional Chinese Medicine practices
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Yeh et al.(3333 Yeh GY, McCarthy EP, Wayne PM, Stevenson LW, Wood MJ, Forman D, et al. Tai chi exercise in patients with chronic heart failure: a randomized clinical trial. Arch Intern Med [Internet]. 2011[cited 2016 Jan 10];171(8):750-7. Available from: http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/227164
http://jamanetwork.com/journals/jamainte...
), 2011USARandomized clinical trialArchives of Internal Medicine |
To determine whether a Tai Chi program over 12 weeks improves ability to perform exercises and quality of life of people with chronic HF as a complement for standard medical care in comparison to health education. |
CG: Two educational weekly sessions over 12 weeks + educational brochures on HF, its pharmacological and non-pharmacological treatments and self-control of symptoms and feelings related to HF (n=50).IG: Two weekly Tai Chi sessions over 12 weeks + educational brochures (n=50).Instrument: MLHFQThere is no mention of which professionals conducted Tai Chi sessions, and CG was conducted by a nurse. |
There was significant QoL improvement in IG compared to CG (p<0.07) after 12 weeks. |
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Traditional Chinese Medicine practices
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Kristen et al.(3434 Kristen AV, Schuhmacher B, Strych K, Lossnitzer D, Friederich HC, Hilbel T, et al. Acupuncture improves exercise tolerance of patients with heart failure: a placebo-controlled pilot study. Heart [Internet]. 2010[cited 2016 Jan 10];96(17):1396-400. Available from: http://heart.bmj.com/content/96/17/1396.long
http://heart.bmj.com/content/96/17/1396....
), 2010GermanyRandomized clinical trialHeart |
To investigate the effects of acupuncture on cardiorespiratory functioning, physical exercise tolerance and QoL of patients with congestive HF. |
CG: Ten placebo sessions twice per week over five weeks (2 cm needle next to real point) (n=8).IG: Ten sessions of auricular acupuncture twice per week over five weeks (n=9),Instrument: SF-36Sessions were performed by an acupuncturist (occupation not mentioned). |
There was improvement in IG in general health subscale (p=0.06) of SF-36 after five weeks. |
