Heart：医疗远程监控或降心衰全因死亡

　　英国一项系统评价和荟萃分析表明，伴有医疗支持的结构性电话支持（STS）和家庭远程监控（TM）有益于出院患者，尤其可降低近期出院心衰患者的全因死亡率。论文5月16日在线发表于《心脏》（Heart）。

　　研究者对包括Medline、EMBASE和PsycINFO在内的14个数据库进行了检索，并纳入伴有同时期对照组的所有随机对照试验（RCT）或观察性队列研究。远程监控（RM）干预包括工办公时间或全天TM以及通过人-人（HH）或人-机（HM）界面提供的STS传送信息。

　　结果显示，共有涉及6317例患者的21项RCT符合纳入标准，其中评估STS、TM和二者兼有的研究分别为11、9和1项。置入监测设备的试验均不符合纳入标准。与常规治疗相比，尽管未达到统计学显著性，但通过STS HH、办公时间TM和全天TM所实施的RM倾向于降低全因死亡率。排除一项对照组优于常规的试验之后，上述各项比较均具有统计学意义。TM干预可降低全因住院率，但STS则非如此。组合治疗可改善健康相关生活质量并且为患者所接受。

Remote monitoring after recent hospital discharge in patients with heart failure: a systematic review and network meta-analysis.
CONTEXT
Readmission to hospital for heart failure is common after recent discharge. Remote monitoring (RM) strategies have the potential to deliver specialised care and management and may be one way to meet the growing needs of the heart failure population.
OBJECTIVE
To determine whether RM strategies improve outcomes for adults who have been recently discharged (<28 days) following an unplanned admission due to heart failure.
STUDY DESIGN
Systematic review and network meta-analysis.
DATA SOURCES
Fourteen electronic databases (including MEDLINE, EMBASE and PsycINFO) were searched to January 2012, and supplemented by hand-searching relevant articles.
STUDY SELECTION
All randomised-controlled trials (RCTs) or observational cohort studies with a contemporaneous control group were included. RM interventions included home telemonitoring (TM) (including implanted monitoring devices) with medical support provided during office hours or 24/7 and structured telephone support (STS) programmes delivered via human-to-human contact (HH) or human-to-machine interface (HM).
DATA EXTRACTION
Data were extracted and validity was assessed independently by two reviewers.
RESULTS
Twenty-one RCTs that enrolled 6317 patients were identified (11 studies evaluated STS (10 of which were HH, while 1 was HM), 9 studies assessed TM, and 1 study assessed both STS and TM). No trial of implanted monitoring devices met the inclusion criteria. Compared with usual care, although not reaching statitistical significance, RM trended to reduce all-cause mortality for STS HH (HR: 0.77, 95% credible interval (CrI): 0.55, 1.08), TM during office hours (HR: 0.76, 95% CrI: 0.49, 1.18) and TM24/7 (HR: 0.49, 95% CrI: 0.20, 1.18). Exclusion of one trial that provided better-than-usual support to the control group rendered each of the above comparisons statistically significant. No beneficial effect on mortality was observed with STS HM. Reductions were also observed in all-cause hospitalisations for TM interventions but not for STS interventions. Care packages generally improved health-related quality-of-life and were acceptable to patients.
CONCLUSIONS
STS HH and TM with medical support provided during office hours showed beneficial trends, particularly in reducing all-cause mortality for recently discharged patients with heart failure. Where 'usual' care is less good, the impact of RM is likely to be greater.