For example there was a significant degree of variability in the intensity (e.g .monitoring during office hours compared with 24 hours per day/seven days per week), and the nature of the technology (e.g. interactive voice response involving the manual input of data using a telephone keypad in response to questions from an interactive voice response system compared to the automatic transmission of physiological data from a measuring device to a central server). The committee also noted that telemonitoring (in a proportion of the included studies) was associated with increased opportunity for people to be contacted by the specialist heart failure team or for people to contact them for advice and support. This made it difficult to ascertain whether the decrease in mortality and hospitalisations were due to the application of telemonitoring or due to the additional access to specialist opinion and care. 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 The committee discussed the potential harms associated with TM. These included the fact that some of the devices used to remotely monitor parameters such as heart rate were unreliable and therefore clinicians were unwilling to base treatment and management decisions on this data. The committee agreed that a lack of user knowledge relating to the technology being employed could result in improper use or overconfidence in the capabilities of the technology. This could lead to people under reporting potentially important symptoms based on the assumption that the system will relay this measurement data directly to the clinician. The potential also exists for people to become dependent on the technology which may impair their ability to self-manage their condition. 