Enhancing Heart Failure Management: A Systematic Review and Meta-Analysis of Continuous Remote Telemedical Management vs. In-Person Visit in Patients with Cardiac Implantable Electronic Devices

Abstract

Background/Objectives: Remote telemedical management (RTM) in heart failure (HF) patients with cardiac implantable electronic devices (CIED) is a reliable approach to follow device-specific and heart failure-related parameters. However, while some positive outcome data is available, results are inconclusive. We aimed to assess the benefits of continuous remote telemonitoring (RTM) compared to the in-person visit (IPV) in reducing all-cause mortality, heart failure hospitalizations (HFH), cardiovascular (CV) deaths, and the occurrence of inappropriate therapy. Methods: The study comprised a systematic review and meta-analysis of randomized controlled trials (RCTs) testing RTM (device-related or other non-invasive telemonitoring systems) vs. IPV for the management of HF patients. The main endpoints were all-cause and CV mortality. Risk of bias and level of evidence were assessed. Hazard ratios (HRs), odds ratios (ORs) and 95% confidence intervals (CI) were calculated. CENTRAL, EMBASE and MEDLINE were searched, and only randomized controlled studies were included. Results: Sixteen RCTs were identified, comprising a total of 11,232 enrolled patients. Seven studies evaluated all-cause mortality, resulting in an OR 0.83 (95% CI 0.72 to 0.96). When CV mortality was assessed, the RTM group showed a significant benefit compared to the IPV group (OR 0.81, 95% CI 0.67 to 0.97). The risk of bias ranged from “low” to “some concerns” for most outcomes, and the certainty was low to moderate depending on the specific outcomes. Conclusions: RTM proved to be superior in reducing all-cause and CV mortality compared to IPV; however, there is a clear need to have standardized alert actions to achieve the mortality benefit.