It was agreed that usual practice is to measure BNP at the point of diagnosis. Repeated measurement is usually done only for specific populations (for example, people awaiting transplant), and by some specialist centres. It was felt that this recommendation, although not substantially different from the previous recommendation, may increase the uptake of NP monitoring in younger, newly diagnosed HFREF patients. Chronic Heart Failure Monitoring NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: 978-1-4731-3093-7 8.4 Telemonitoring and self-monitoring Telemonitoring and self monitoring in people with heart failure has been a area of interest not only amongst clinicians in primary and community care, but also with commissioners of services. The main drive for its use has been the perception that these interventions could reduce the need for face-to- face contact with patients, and promote self care. The 2010 guidelines did not make any recommendations for its implementation due to the difficulty in interpreting whether the differences shown in the outcomes were due to the monitoring intervention or the additional access provided to specialist care. Current use of these methods of monitoring patients remains patchy throughout the country Telemonitoring techonology has developed since publication of the last guideline, and the publication of further reviews and studies prompted the question of the clinical and cost effectiveness of telemonitoring to be revisited. 8.4.2 Review question: What is the clinical and cost effectiveness of telemonitoring and self- monitoring compared with usual care, in people with heart failure? For full details see review protocol in appendix A. Table 89: PICO characteristics of review question Population People with heart failure in a community or outpatient setting. 