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Understanding heart failure; explaining telehealth – a hermeneutic systematic review

Overview of attention for article published in BMC Cardiovascular Disorders, June 2017
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About this Attention Score

  • In the top 5% of all research outputs scored by Altmetric
  • One of the highest-scoring outputs from this source (#1 of 1,290)
  • High Attention Score compared to outputs of the same age (99th percentile)

Mentioned by

2 policy sources
415 tweeters
1 Facebook page


66 Dimensions

Readers on

305 Mendeley
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Understanding heart failure; explaining telehealth – a hermeneutic systematic review
Published in
BMC Cardiovascular Disorders, June 2017
DOI 10.1186/s12872-017-0594-2
Pubmed ID

Trisha Greenhalgh, Christine A’Court, Sara Shaw


Enthusiasts for telehealth extol its potential for supporting heart failure management. But randomised trials have been slow to recruit and produced conflicting findings; real-world roll-out has been slow. We sought to inform policy by making sense of a complex literature on heart failure and its remote management. Through database searching and citation tracking, we identified 7 systematic reviews of systematic reviews, 32 systematic reviews (including 17 meta-analyses and 8 qualitative reviews); six mega-trials and over 60 additional relevant empirical studies and commentaries. We synthesised these using Boell's hermeneutic methodology for systematic review, which emphasises the quest for understanding. Heart failure is a complex and serious condition with frequent co-morbidity and diverse manifestations including severe tiredness. Patients are often frightened, bewildered, socially isolated and variably able to self-manage. Remote monitoring technologies are many and varied; they create new forms of knowledge and new possibilities for care but require fundamental changes to clinical roles and service models and place substantial burdens on patients, carers and staff. The policy innovation of remote biomarker monitoring enabling timely adjustment of medication, mediated by "activated" patients, is based on a modernist vision of efficient, rational, technology-mediated and guideline-driven ("cold") care. It contrasts with relationship-based ("warm") care valued by some clinicians and by patients who are older, sicker and less technically savvy. Limited uptake of telehealth can be analysed in terms of key tensions: between tidy, "textbook" heart failure and the reality of multiple comorbidities; between basic and intensive telehealth; between activated, well-supported patients and vulnerable, unsupported ones; between "cold" and "warm" telehealth; and between fixed and agile care programmes. The limited adoption of telehealth for heart failure has complex clinical, professional and institutional causes, which are unlikely to be elucidated by adding more randomised trials of technology-on versus technology-off to an already-crowded literature. An alternative approach is proposed, based on naturalistic study designs, application of social and organisational theory, and co-design of new service models based on socio-technical principles. Conventional systematic reviews (whose goal is synthesising data) can be usefully supplemented by hermeneutic reviews (whose goal is deepening understanding).

Twitter Demographics

The data shown below were collected from the profiles of 415 tweeters who shared this research output. Click here to find out more about how the information was compiled.

Mendeley readers

The data shown below were compiled from readership statistics for 305 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Unknown 305 100%

Demographic breakdown

Readers by professional status Count As %
Student > Ph. D. Student 47 15%
Researcher 42 14%
Student > Master 36 12%
Student > Bachelor 26 9%
Other 18 6%
Other 55 18%
Unknown 81 27%
Readers by discipline Count As %
Medicine and Dentistry 59 19%
Nursing and Health Professions 44 14%
Social Sciences 31 10%
Psychology 13 4%
Engineering 12 4%
Other 54 18%
Unknown 92 30%

Attention Score in Context

This research output has an Altmetric Attention Score of 246. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 27 August 2020.
All research outputs
of 19,542,586 outputs
Outputs from BMC Cardiovascular Disorders
of 1,290 outputs
Outputs of similar age
of 284,486 outputs
Outputs of similar age from BMC Cardiovascular Disorders
of 1 outputs
Altmetric has tracked 19,542,586 research outputs across all sources so far. Compared to these this one has done particularly well and is in the 99th percentile: it's in the top 5% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 1,290 research outputs from this source. They receive a mean Attention Score of 3.6. This one has done particularly well, scoring higher than 99% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 284,486 tracked outputs that were published within six weeks on either side of this one in any source. This one has done particularly well, scoring higher than 99% of its contemporaries.
We're also able to compare this research output to 1 others from the same source and published within six weeks on either side of this one. This one has scored higher than all of them