Background:
In heart failure (HF) patients, remote monitoring of hemodynamics using implantable devices may be used to predict and reduce HF exacerbations.
Methods:
A meta-analysis of randomized controlled trials (RCTs) testing remote monitoring versus standard of care for management of HF patients was performed. Endpoints included all-cause mortality and Cardiovascular (CV)/HF hospitalizations. Risk Ratios (RR) and 95% confidence intervals (CI) were calculated for each endpoint. A secondary analysis tested for heterogeneity of treatment effect (HTE) using Chi
2
and I
2
tests comparing implanted right ventricular/pulmonary pressure monitoring versus impedance-based monitoring on HF hospitalization.
Results:
10 RCTs (n=6,020) were identified with a mean follow-up of 1.74 years. The mean age and reported ejection fraction were 64.1 and 27.1%, respectively. Remote monitoring did not reduce mortality (RR 0.88, [95% CI 0.76, 1.03]) or CV/HF hospitalizations (RR 0.99, [0.81, 1.20]) (Figure 1). When performing the test of subgroup differences, there was significant HTE for HF hospitalization between those studies that used implanted right ventricular/pulmonary pressure monitoring versus impedance-based monitoring (Chi
2
= 7.92, p = 0.005, I
2
= 87.4%).
Conclusions:
Compared to standard of care, remote monitoring of physiologic markers of HF did not reduce mortality and CV or HF hospitalization. However, right ventricular/pulmonary pressure monitoring may reduce HF hospitalization compared to impendence-based monitoring. Further studies are necessary to evaluate the role of remote monitoring in patients with heart failure.
Effects of right ventricular septum or His-bundle pacing versus right ventricular apical pacing on cardiac function: A systematic review and meta-analysis of randomized controlled trials