Enhancing heart failure management: a comprehensive analysis of continuous remote monitoring vs. standard care in patients with cardiac implantable electronic devices

Abstract

Abstract Background Utilizing remote monitoring (RM) in patients with heart failure (HF) who have cardiac implantable electronic devices (CIED) proves to be a dependable method for closely adhering to device-specific and heart failure-related parameters. While there is some favorable outcome data, the results remain incomplete. Aims We aimed to evaluate the advantages of continuous RM compared to the standard of care (SoC) in reducing all-cause mortality, cardiovascular-related death (CV), sudden cardiac death, and ICD shocks. Methods A systematic review and meta-analysis of randomized controlled trials (RCT) testing RM vs. SoC for the management of HF patients were performed. Endpoints were all-cause mortality, CV mortality, sudden cardiac death, ICD shocks. Odds ratios (ORs), Hazard ratios (HRs) and 95% confidence intervals (CI) were calculated. CENTRAL, EMBASE and MEDLINE were searched up, and only randomized controlled studies were included. Results Sixteen RCTs that enrolled a total of 11,140 patients were identified to evaluate all-cause mortality, resulting in an HR 0.83 (95% CI 0.72 to 0.96). When CV mortality was assessed, there was a significant difference between the RM group and SoC group, and the HR was 0.81 (95% CI 0.67 to 0.97) Moreover RM did not have an effect on the rate of sudden cardiac death and ICD shocks. Conclusions RM proved to be superior in reducing all-cause mortality and CV mortality compared to SoC despite of the heterogeneous study cohorts and unstandardized alert actions. However, the use of RM did not influence the occurrence of sudden cardiac death and ICD shocks.