Evidence
This page contains a snapshot of featured content which highlights evidence addressing key clinical questions including areas of uncertainty. Please see the main topic reference list for details of all sources underpinning this topic.
BMJ Best Practice evidence tables
Evidence tables provide easily navigated layers of evidence in the context of specific clinical questions, using GRADE and a BMJ Best Practice Effectiveness rating. Follow the links at the bottom of the table, which go to the related evidence score in the main topic text, providing additional context for the clinical question. Find out more about our evidence tables.
This table is a summary of the analysis reported in a Cochrane Clinical Answer that focuses on the above important clinical question.
Confidence in the evidence is high or moderate to high where GRADE has been performed and there is no difference in effectiveness between the intervention and comparison for key outcomes.
Population: Adults (mean age 53 to 79 years) with heart failure
Intervention: Telemedicine (includes remote monitoring with system for alerting healthcare professionals, automatic clinical review of data, and/or videoconferencing for patient assessment and self-management education and support) with or without usual care
Comparison: Usual care (where reported: home nursing visits or pharmacological treatment)
| Outcome | Effectiveness (BMJ rating)? | Confidence in evidence (GRADE)? |
|---|---|---|
All‐cause mortality at median 6 months’ follow‐up ᵃ | No statistically significant difference | High |
Disease‐specific quality of life at median 3 months’ follow‐up | Favours intervention | Moderate |
All‐cause hospital admissions at median 8 months’ follow‐up: monitoring with clinical review of data | Unknown ᵇ | Moderate |
All‐cause hospital admissions at median 8 months’ follow‐up: monitoring with alerts | Unknown ᶜ | Moderate |
Heart failure and/or cardiovascular‐related admissions at 3-12 months’ follow‐up | Unknown ᵈ | GRADE assessment not performed for this outcome |
Emergency department and urgent care visits at median 4 months’ follow‐up | No statistically significant difference | GRADE assessment not performed for this outcome |
Length of stay at median 6 months’ follow‐up | No statistically significant difference | GRADE assessment not performed for this outcome |
Length of stay related to heart failure at median 6 months’ follow‐up | No statistically significant difference | GRADE assessment not performed for this outcome |
Adverse effects | - | None of the studies identified by the review assessed this outcome |
Note ᵃ The Cochrane Clinical Answer (CCA) notes that there was a reduction in mortality with telemedicine that did not quite meet statistical significance. ᵇ Results reported narratively (2 RCTs with 156 people; 1 favoured telemedicine while the other reported no statistically significant difference between treatment groups). ᶜ Results reported narratively (9 RCTs with 4373 people, all of which reported no statistically significant difference between treatment groups, apart from 1 which favoured telemedicine). ᵈ Results reported narratively (16 studies with 3236 people, 3 of which reported a reduction in heart failure and/or cardiovascular-related admissions with telemedicine, while the other studies reported similar rates of admission between treatment groups).
This evidence table is related to the following section/s:
Cochrane Clinical Answers
Cochrane Clinical Answers (CCAs) provide a readable, digestible, clinically focused entry point to rigorous research from Cochrane systematic reviews. They are designed to be actionable and to inform decision making at the point of care and have been added to relevant sections of the main Best Practice text.
- What are the benefits and harms of disease management interventions for adults with heart failure?
- How does nurse-led titration of heart failure medication compare with usual care for heart failure with reduced ejection fraction?
- What are the effects of exercise‐based cardiac rehabilitation for adults with heart failure?
- What are the benefits and harms of structured telephone support or non-invasive telemonitoring in patients with heart failure?
- What are the benefits and harms of natriuretic peptide–guided treatment for people with heart failure?
- In people with heart failure, what are the effects of interactive telemedicine?
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