The effect of Remote Monitor vs Standard of Care therapy on outcome A systematic review and meta-analysis

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – EU funding. Main funding source(s): Project no. RRF-2.3.1-21-2022-00004 (MILAB) has been implemented with the support provided by the European Union. Background Remote monitoring (RM) in heart failure (HF) patients with cardiac implantable electronic devices (CIED) is a reliable approach to strictly following the device-specific and heart failure-related parameters. Despite a few positive outcome data, results are incomprehensive. Aims We aimed to assess the benefit of continuous RM vs. standard of care (SoC) in the reduction of all-cause mortality, heart failure hospitalization (HF), and cardiovascular-related hospitalization (CV), and inappropriate therapy. Methods A systematic review and meta-analysis of randomized controlled trials (RCT) testing RM vs. SoC for the management of HF patients were performed. Endpoints were all-cause mortality, CV- and HF hospitalizations and inappropriate therapy. Odds ratios (ORs) and 95% confidence intervals (CI) were calculated. CENTRAL, EMBASE and MEDLINE were searched up to 21th of December 2021. Only randomized controlled studies were included. Results Fourteen RCTs that enrolled a total of 8370 patients were identified to evaluate all-cause mortality, resulting in an OR 0.88 (95% CI 0.75 to 1.03). When CV - and HF hospitalizations were assessed, there were no differences between the RM group and SoC group, and the OR was 0.93 (95% CI 0.82 to 1.05) and 0.95 (95% CI 0.75 to 1.19), respectively.Moreover RM did not have an effect on the rate of inappropriate therapy, OR was 0.73. (95% CI 0.30 to 1.81). Conclusions RM proved to be non-inferior in reducing all-cause mortality, CV- and HF hospitalization and rate of inappropriate therapy when compared to standard of care despite of the heterogeneous study cohorts and unstandardized alert actions.