***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Aim To determine the effectiveness and cost-effectiveness of a mobile phone intervention to improve exercise capacity and physical activity behaviour in people with ischaemic heart disease ( IHD ) . Methods and results In this single-blind , parallel , two-arm , r and omized controlled trial adults ( n = 171 ) with IHD were r and omized to receive a mobile phone delivered intervention  ( HEART ; n = 85 ) plus usual care , or usual care alone ( n = 86 ) . Adult participants aged 18 years or more , with a diagnosis of IHD , were clinical ly stable as out patients , able to perform exercise , able to underst and and write English , and had access to the Internet . The HEART ( Heart Exercise And Remote Technologies ) intervention involved a personalized , automated package of text messages and a secure website with video messages aim ed at increasing exercise behaviour , delivered over 24 weeks . All participants were able to access usual community-based cardiac rehabilitation , which involves encouragement of physical activity and an offer to join a local cardiac support club . All outcomes were assessed at baseline and 24 weeks and included peak oxygen uptake ( PVO2 ; primary outcome ) , self-reported physical activity , health-related quality of life , self-efficacy and motivation ( secondary outcomes ) . Results showed no differences in PVO2 between the two groups ( difference −0.21 ml kg−1 min−1 , 95 % CI : −1.1 , 0.7 ; p = 0.65 ) at 24 weeks . However significant treatment effects were observed for selected secondary outcomes , including leisure time physical activity ( difference 110.2 min/week , 95 % CI : −0.8 , 221.3 ; p = 0.05 ) and walking ( difference 151.4 min/week , 95 % CI : 27.6 , 275.2 ; p = 0.02 ) . There were also significant improvements in self-efficacy to be active ( difference 6.2 % , 95 % CI : 0.2 , 12.2 ; p = 0.04 ) and the general health domain of the SF36 ( difference 2.1 , 95 % CI : 0.1 , 4.1 ; p = 0.03 ) at 24 weeks . The HEART programme was considered likely to be cost-effective for leisure time activity and walking . Conclusions A mobile phone intervention was not effective at increasing exercise capacity over and above usual care . The intervention was effective and probably cost-effective for increasing physical activity and may have the potential to augment existing cardiac rehabilitation services Background Several heart failure studies have shown promising results for implementing telehealthcare . These studies have led to clinical and political interest in telehealthcare as a way to improve heart failure outcomes and lower costs . However , there is a need for large-scale clinical trials with cost-effectiveness assessment s. Methods / design The present study is known as the TeleCare North Heart Failure Trial in Denmark . We are study ing the health effectiveness and cost-effectiveness of a telehealth ( Telekit ) solution compared with usual care for patients with heart failure . The design is a multicenter , two-arm , parallel-group , nonblinded , superiority r and omized controlled trial . Outpatient healthcare centers will be responsible for recruiting eligible participants ( 600 participants are expected ) for the trial in the geographic area of the North Denmark Region . Participants are qualified for inclusion if they have been diagnosed according to national guidelines and are categorized in New York Heart Association class 2 , 3 , or 4 . Patients must have a permanent residence and be motivated to use telehealth care . The primary outcomes are changes in health-related quality of life ( assessed using the Kansas City Cardiomyopathy Question naire , the EuroQol EQ-5D-5L question naire , and the Short Form Health Survey [ SF-36 ] ) and in the incremental cost-effectiveness ratio measured from baseline to follow-up . The secondary outcomes are changes in mortality and in physiological indicators such as blood pressure , pulse , and weight . Discussion The TeleCare North Heart Failure Trial is intended to improve the international evidence base for the health effectiveness and cost-effectiveness of telehealthcare for patients with heart failure . The expectation is that the results of the trial can be generalized to all municipalities in Denmark and serve as an inspiration for further international research .Trial registration Clinical Trials.gov ( NCT02860013 ) . Registered on 28 July 2016 Aim Although cardiac rehabilitation improves physical fitness after a cardiac event , many eligible patients do not participate in cardiac rehabilitation and the beneficial effects of cardiac rehabilitation are often not maintained over time . Home-based training with telemonitoring guidance could improve participation rates and enhance long-term effectiveness . Methods and results We r and omised 90 low-to-moderate cardiac risk patients entering cardiac rehabilitation to three months of either home-based training with telemonitoring guidance or centre-based training . Although training adherence was similar between groups , satisfaction was higher in the home-based group ( p = 0.02 ) . Physical fitness improved at discharge ( p < 0.01 ) and at one-year follow-up ( p < 0.01 ) in both groups , without differences between groups ( home-based p = 0.31 and centre-based p = 0.87 ) . Physical activity levels did not change during the one-year study period ( centre-based p = 0.38 , home-based p = 0.80 ) . Healthcare costs were statistically non-significantly lower in the home-based group ( € 437 per patient , 95 % confidence interval –562 to 1436 , p = 0.39 ) . From a societal perspective , a statistically non-significant difference of € 3160 per patient in favour of the home-based group was found ( 95 % confidence interval –460 to 6780 , p = 0.09 ) and the probability that it was more cost-effective varied between 97 % and 75 % ( willingness-to-pay of € 0 and € 100,000 per quality -adjusted life-years , respectively ) . Conclusion We found no differences between home-based training with telemonitoring guidance and centre-based training on physical fitness , physical activity level or health-related quality of life . However , home-based training was associated with a higher patient satisfaction and appears to be more cost-effective than centre-based training . We conclude that home-based training with telemonitoring guidance can be used as an alternative to centre-based training for low-to-moderate cardiac risk patients entering cardiac rehabilitation Objectives To compare the costs and cost-effectiveness of managing patients with uncontrolled blood pressure ( BP ) using telemonitoring versus usual care from the perspective of the National Health Service ( NHS ) . Design Within trial post hoc economic evaluation of data from a pragmatic r and omised controlled trial using an intention-to-treat approach . Setting 20 socioeconomically diverse general practice s in Lothian , Scotl and . Participants 401 primary care patients aged 29–95 with uncontrolled daytime ambulatory blood pressure ( ABP ) ( ≥135/85 , but < 210/135 mm Hg ) . Intervention Participants were central ly r and omised to 6 months of a telemonitoring service comprising of self-monitoring of BP transmitted to a secure website for review by the attending nurse/doctor and patient , with optional automated patient decision-support by text/email ( n=200 ) or usual care ( n-201 ) . R and omisation was undertaken with minimisation for age , sex , family practice , use of three or more hypertension drugs and self-monitoring history . Main outcome measures Mean difference in total NHS costs between trial arms and blinded assessment of mean cost per 1 mm Hg systolic BP point reduced .  Results Home telemonitoring of BP costs significantly more than usual care ( mean difference per patient £ 115.32 ( 95 % CI £ 83.49 to £ 146.63 ; p<0.001 ) ) . Increased costs were due to telemonitoring service costs , patient training and additional general practitioner and nurse consultations . The mean cost of systolic BP reduction was £ 25.56/mm Hg ( 95 % CI £ 16.06 to £ 46.89 ) per patient . Conclusions Over the 6-month trial period , supported telemonitoring was more effective at reducing BP than usual care but also more expensive . If clinical gains are maintained , these additional costs would be very likely to be compensated for by reductions in the cost of future cardiovascular events . Longer-term modelling of costs and outcomes is required to fully examine the cost-effectiveness implication s. Trial registration International St and ard R and omised Controlled Trials , number IS RCT N72614272 Aims The purpose of this prospect i ve study was to investigate whether internet-based remote monitoring offers a safe , practical , and cost-effective alternative to the in-office follow-up visits of patients with an implantable cardioverter defibrillator ( ICD ) . Methods and results Forty-one patients ( 62 ± 10 years , range 41–76 , 83 % male ) with previously implanted ICD were followed for 9 months . One-hundred and nineteen scheduled and 18 unscheduled data transmissions were performed . There were no device-related adverse events . Over 90 % of the patients found the system easy to use . Physicians reported the system as being ‘ very easy ’ or ‘ easy ’ to use and found the data comparable to traditional device interrogation in 99 % of the cases . They were able to address all unscheduled data transmissions remotely . Compared with the in-office visits , remote monitoring required less time from patients ( 6.9 ± 5.0 vs. 182 ± 148 min , P < 0.001 ) and physicians ( 8.4 ± 4.5 vs. 25.8 ± 17.0 min , P < 0.001 ) to complete the follow-up . Substitution of two routine in-office visits during the study by remote monitoring reduced the overall cost of routine ICD follow-up by 524 € per patient ( 41 % ) . Conclusion Remote monitoring offers a safe , feasible , time-saving , and cost-effective solution to ICD follow-up Objectives To investigate the cost-effectiveness of a telehealth intervention for primary care patients with raised cardiovascular disease ( CVD ) risk . Design A prospect i ve within-trial patient-level economic evaluation conducted alongside a r and omised controlled trial . Setting Patients recruited through primary care , and intervention delivered via telehealth service .  Participants Adults with a 10-year CVD risk ≥20 % , as measured by the QRISK2 algorithm , with at least 1 modifiable risk factor . Intervention A series of up to 13 scripted , theory-led telehealth encounters with healthcare advisors , who supported participants to make behaviour change , use online re sources , optimise medication and improve adherence . Participants in the control arm received  usual care . Primary and secondary outcome measures Cost-effectiveness measured by net monetary benefit at the end of 12 months of follow-up , calculated from incremental cost and incremental quality -adjusted life years ( QALYs ) . Productivity impacts , participant out-of-pocket expenditure and the clinical outcome were presented in a cost-consequences framework . Results 641 participants were r and omised—325 to receive the telehealth intervention in addition to usual care and 316 to receive only usual care . 18 % of participants had missing data on either costs , utilities or both . Multiple imputation was used for the base case results . The intervention was associated with incremental mean per-patient National Health Service ( NHS ) costs of £ 138 ( 95 % CI 66 to 211 ) and an incremental QALY gain of 0.012 ( 95 % CI −0.001 to 0.026 ) . The incremental cost-effectiveness ratio was £ 10 859 . Net monetary benefit at a cost-effectiveness threshold of £ 20 000 per QALY was £ 116 ( 95 % CI −58 to 291 ) , and the probability that the intervention was cost-effective at this threshold value was 0.77 . Similar results were obtained from a complete case analysis . Conclusions There is evidence to suggest that the Healthlines telehealth intervention was likely to be cost-effective at a threshold of £ 20 000 per QALY . Trial registration number IS RCT N27508731 ; Results . Prospect ively registered 05 July 2012 Background Heart failure patients with implantable defibrillators place a significant burden on health care systems . Remote monitoring allows assessment of device function and heart failure parameters , and may represent a safe , effective , and cost-saving method compared to conventional in-office follow-up . Objective We hypothesized that remote device monitoring represents a cost-effective approach . This paper summarizes the economic evaluation of the Evolution of Management Strategies of Heart Failure Patients With Implantable Defibrillators ( EVOLVO ) study , a multicenter clinical trial aim ed at measuring the benefits of remote monitoring for heart failure patients with implantable defibrillators . Methods Two hundred patients implanted with a wireless transmission – enabled implantable defibrillator were r and omized to receive either remote monitoring or the conventional method of in-person evaluations . Patients were followed for 16 months with a protocol of scheduled in-office and remote follow-ups . The economic evaluation of the intervention was conducted from the perspectives of the health care system and the patient . A cost-utility analysis was performed to measure whether the intervention was cost-effective in terms of cost per quality -adjusted life year ( QALY ) gained . Results Overall , remote monitoring did not show significant annual cost savings for the health care system ( € 1962.78 versus € 2130.01 ; P=.80 ) 
    Output:
    
According to the results ,  telemedicine improves the clinical outcomes and results in considerable saving in costs .
Utilizing telemedicine concurrent with the usual care for service delivery is more cost-effective .