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Meta-Analysis
. 2022 Dec;24(12):2333-2341.
doi: 10.1002/ejhf.2655. Epub 2022 Sep 11.

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

Andrea Zito  1 , Giuseppe Princi  1 , Giulio Francesco Romiti  2 , Mattia Galli  1   3 , Stefania Basili  2 , Giovanna Liuzzo  1   4 , Tommaso Sanna  1   4 , Attilio Restivo  1 , Giuseppe Ciliberti  1 , Carlo Trani  1   4 , Francesco Burzotta  1   4 , Alfredo Cesario  5   6 , Gianluigi Savarese  7 , Filippo Crea  1   4 , Domenico D'Amario  1   4
Affiliations
Meta-Analysis

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

Andrea Zito et al. Eur J Heart Fail. 2022 Dec.

Abstract

Aims: Pre-clinical congestion markers of worsening heart failure (HF) can be monitored by devices and may support the management of patients with HF. We aimed to assess whether congestion-guided HF management according to device-based remote monitoring strategies is more effective than standard therapy.

Methods and results: A comprehensive literature research for randomized controlled trials (RCTs) comparing device-based remote monitoring strategies for congestion-guided HF 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 HF hospitalizations. Secondary endpoints included the individual components of the primary outcome. A total of 4347 patients from eight RCTs were included. Findings varied according to the type of parameters monitored. Compared with standard therapy, haemodynamic-guided strategy (4 trials, 2224 patients, 12-month follow-up) reduced the risk of the primary composite outcome (IRR 0.79, 95% CI 0.70-0.89) and HF hospitalizations (IRR 0.76, 95% CI 0.67-0.86), without a significant impact on all-cause death (IRR 0.93, 95% CI 0.72-1.21). In contrast, impedance-guided strategy (4 trials, 2123 patients, 19-month follow-up) did not provide significant benefits.

Conclusion: Haemodynamic-guided HF management is associated with better clinical outcomes as compared to standard clinical care.

Keywords: Death; Guided management; Heart failure; Hospitalization; Remote monitoring; Telemonitoring.

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Figures

Figure 1
Figure 1
Guided management versus standard therapy for the primary outcome. CI, confidence interval; IRR, incidence rate ratio; Time, patient‐years.
Figure 2
Figure 2
Guided management versus standard therapy for the all‐cause death outcome. CI, confidence interval; IRR, incidence rate ratio; Time, patient‐years.
Figure 3
Figure 3
Guided management versus standard therapy for the heart failure hospitalization outcome. CI, confidence interval; IRR, incidence rate ratio; Time, patient‐years.
See this image and copyright information in PMC

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