Long-term impact of remote monitoring after hospitalisations for acute decompensated heart failure: a systematic review and meta-analysis of randomised controlled trials

Abstract

Abstract Background Remote monitoring (RM) has demonstrated to improve outcomes of patients with heart failure (HF) in different settings. However, the long-term efficacy of RM after discharge of patients hospitalised for acute decompensated heart failure (ADHF) remains uncertain. Purpose We aimed to perform a systematic review and meta-analysis comparing RM with usual care (UC) in patients recently hospitalised for ADHF. Methods We systematically searched PubMed, EMBASE, and Cochrane Library in February 2023 in accordance with PRISMA guidelines for randomised controlled trials (RCTs) comparing RM with UC initiated within 6 weeks of discharge after an admission for ADHF, with a minimum follow-up of 6 months. Statistical analyses were performed using R Software 4.1.0., and heterogeneity was assessed using I² statistics. We extracted the data following the intention-to-treat principle. Results We included six RCTs comprising 2,817 patients, of whom 1,436 (51.0%) were randomised to RM. Follow-up ranged from 6 to 15 months. In the pooled analysis, RM was associated with a significant reduction in cardiovascular mortality (OR 0.59; 95% CI 0.36–0.97; p=0.036; I²=0%; Fig. 1A) and cardiovascular hospitalisations (OR 0.71; 95% CI 0.57–0.88; p=0.002; I²=0%; Fig. 1B), with a low heterogeneity between studies. Nonetheless, there was no significant difference between RM and UC with regards to hospitalisations for HF (OR 0.88; 95% CI 0.67–1.15; p=0.340; I²=66%; Fig. 2A) or all-cause hospitalisations (OR 0.89; 95% CI 0.73–1.08; p=0.241; I²=67%; Fig. 2B), albeit with a high heterogeneity between studies. Conclusion In this meta-analysis, post-discharge RM was associated with a reduction in cardiovascular mortality and cardiovascular hospitalisations rates as compared with UC in patients admitted for ADHF.Figure 1Figure 2