LAUSR

In this issue of the Journal, Galinier et al.1 report a randomised trial of care supported by home telemonitoring including almost 1000 patients with heart failure. Telemonitoring consisted of questions about symptoms and daily weights. Data were relayed to a secure server, which generated alerts, to which nurses responded, during routine working hours, by advising patients whether they should contact their family practitioner or cardiologist. Compliance with measuring weight was often poor. We are not told how many patients contacted a doctor, what advice they received, or whether they complied with it. This complex chain of communication is only as strong as its weakest link. The trial was neutral for its composite primary endpoint, unplanned hospitalisation for heart failure or all-cause mortality (rate ratio 0.97; P = 0.80), and for all pre-specified secondary endpoints. A further analysis, focussing on first unplanned hospitalisation for heart failure, suggested a modest improvement (hazard ratio 0.79; P = 0.044), that was driven by larger effects in those who weighed themselves regularly or had greater functional limitation or who were more socially isolated. Some will view this trial as further evidence that home telemonitoring is ineffective for heart failure, ignoring the overall positive effect identified by systematic reviews.2–4 Others will suggest the trial was neutral because of inadequate technology, lack of a robust and timely response to