Telemonitoring modalities in heart failure: comparative effectiveness across the heart failure population—a meta-analysis

Le résumé fourni par la source

Remote monitoring (RM) is effective for managing heart failure (HF), but it remains unclear which patients benefit most from which RM modality. We conducted a meta-analysis of 79 randomised trials including 31,669 patients comparing RM with standard care for total and first HF hospitalisations and all-cause mortality. Subgroup analyses evaluated effects by geographic region and HF status, and meta-regression assessed the influence of age, left ventricular ejection fraction, New York Heart Association class, sex, and publication year. Network meta-analysis ranked RM modalities using Surface Under the Cumulative Ranking scores. Overall, RM reduced total HF hospitalisations (incidence rate ratio 0.81, 95% confidence interval [CI] 0.72-0.91), first HF hospitalisations (risk ratio 0.82, 95% CI: 0.76-0.88), and all-cause mortality (risk ratio 0.90, 95% CI: 0.84-0.95). Subgroup and meta-regression analyses showed consistent benefits across patient and study characteristics without significant interaction effects. In network meta-analysis, invasive hemodynamic monitoring ranked highest for reducing total HF hospitalisations, while structured telephone support ranked highest for reducing first HF hospitalisation and all-cause mortality. RM consistently improves HF outcomes across a range of patient and study characteristics, supporting its broad use. However, based on these characteristics, current evidence does not allow targeted RM implementation for specific patients most likely to benefit.

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