Device-based remote monitoring strategies for guided management of patients with heart failure: a systematic review and meta-analysis

Abstract

Background Preclinical predictors of worsening heart failure can be monitored by implanted devices and may support the management of patients with heart failure. However, clinical results of such an approach are controversial. Purpose We aimed to assess if guided heart failure management according to device-based remote monitoring strategies is more effective than standard therapy. Methods A comprehensive literature research for randomized controlled trials (RCTs) comparing a strategy of guided heart failure management versus standard therapy was performed on PubMed, Embase, and CENTRAL databases. Incidence rate ratios (IRRs) and associated 95% confidence intervals (CIs) were calculated using the Poisson regression model with random study effects. The primary outcome was a composite of all-cause death and hospitalizations for heart failure. Secondary endpoints included the individual components of the primary outcome. Results A total of 9216 patients from 14 RCTs were included. The average follow-up duration was of 16 months. Compared with standard therapy, guided heart failure management reduced the risk of the composite of all-cause death and hospitalizations for heart failure (IRR 0.86, 95% CI 0.79–0.94, p<0.001), driven by a reduction in both all-cause death (IRR 0.88, 95% CI 0.77–1.00, p=0.049) and hospitalizations for heart failure (IRR 0.83, 95% CI 0.75–0.92, p<0.001). Findings varied according to the type of parameters monitored, with haemodynamic-guided and multiparameter-guided strategies yielding favorable effects, while impedance-guided strategy was not able to provide significant benefits. Conclusion Device-based remote monitoring systems as a tool to guide the management of patients with heart failure were associated with a valuable reduction in the risks of death, hospitalizations for heart failure, and the composite of both, supporting their routine use in clinical practice. Funding Acknowledgement Type of funding sources: None.