A number of the QoL outcomes were also associated with a large degree of uncertainty due to wide confidence intervals surrounding the effect estimate again making it difficult for the committee to interpret the true clinical effect. The committee agreed that the impact of STS on QoL would be variable depending on the persons willingness to engage with the intervention and the specific focus of the STS. For example STS that mainly focused on highlighting worrying symptoms might not have the same effect as an intervention aimed at providing education and support. Only one study reported patient adherence to STS which showed no clinically important effect. The committee agreed that in practice adherence to STS would be variable depending on the intensity and focus of the intervention and the motivation of the individual. The committee discussed the potential harms associated with STS. The committee agreed that a proportion of elderly patients found it alarming when their phone rang, had difficulty using or did not like using their phone and this caused them a significant degree of anxiety. Monitoring the signs and symptoms of heart failure on a regular basis may also provoke anxiety in some people due to the distress associated with having attention drawn to their diagnosis. The committee acknowledged that using ad hoc telephone appointments and calls to the appropriate clinicians was a relevant form of providing Chronic Heart Failure Monitoring NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: 978-1-4731-3093-7 Recommendations No recommendation Research recommendation No research recommendation support and managing a number of symptoms for people with heart failure. However, the committee did not feel as though the evidence supported a recommendation to offer or not offer structured telephone support and decided not to make a recommendation. 