The potential also exists for people to become dependent on the technology which may impair their ability to self-manage their condition. Similar to STS, the committee noted that monitoring the signs and symptoms of heart failure on a regular basis provoked anxiety in some people and made them hyperaware of their symptoms. The committee also agreed that a lack of user support regarding the specific TM technologies could compromise motivation and willingness to engage with the technology resulting in compliance and adherence issues which could negatively impact patient safety. The committee also agreed that telemonitoring could result in a reduction in face-to-face care. This has the potential to hinder thorough clinical assessment and good treatment decisions. The use of telemonitoring may also have a negative impact on the ability of both the care giver and receiver to establish a good clinical relationship which the committee noted was fundamental to the quality and safety of the care provided. The committee acknowledged that for a subset of specific and vulnerable people this form of monitoring would be appropriate and may be of benefit when provided for a specific length of time and for a specific purpose. In addition, the committee recognised that there was a potential inequality issue for people living in rural areas with a substantial travel time to specialist care centres. For these people telemonitoring may be appropriate and this decision should be made at an individual level. The committee did not feel as though the evidence supported a recommendation to offer or not offer TM and decided not to make a recommendation. Trade-off between net clinical effects and costs Six published economic evaluations were identified for this review. 