Guiding the management of patients with heart failure (HF) using implant-based remote monitoring significantly reduces all-cause death and HF hospitalizations and may be a widely applicable strategy, according to findings published in the International Journal of Cardiology.
Investigators sought to compare implant-based multiparameter remote monitoring vs standard of care for guided HF management. A composite of HF hospitalizations and all-cause death was the primary outcome. HF hospitalizations and all-cause death considered independently were the secondary endpoints.
The investigators conducted a systematic review and meta-analysis searching Embase, CENTRAL, and PubMed databases for articles comparing implant-based multiparameter-guided management for HF vs standard of care in randomized controlled trials (RCTs) without restriction for publication date, language, or follow-up duration. They included 6 RCTs (TRUST, REM-HF, IN-TIME, RESULT, TELECART, ECOST) in a meta-analysis (N=4869) with an average of 18 months of follow-up (n=2674 multiparameter-guided management; n=2195 standard of care). The Cochrane Collaboration risk-of-bias tool was used to assess risk of bias and determined 3 studies had low risk and 3 studies had some risk.
Implant-based remote monitoring vs standard of care significantly reduced the independent events of HF hospitalization (incidence rate ratio [IRR], 0.75; 95% CI, 0.61-0.93; P =.007) and all-cause death (IRR, 0.80; 95% CI, 0.66-0.96; P =.017) resulting in significantly reduced risk of the primary composite outcome (IRR, 0.83; 95% CI, 0.71-0.99; P =.033, I2=40%). HF hospitalizations were not reported by 2 of the studies (TRUST, REM-HF).
No trial exerted excessive influence on the pooled estimate for HF hospitalizations in leave-1-out sensitivity analyses. However, non-significance was reached for all-cause death when the IN-TIME trial was excluded, and the primary composite outcome showed a non-significant result with the exclusion of 4 trials (IN-TIME, RESULT, TELECART, TRUST).
There was a marginal direct relationship between the primary composite outcome and atrial fibrillation and New York Heart Association functional class II in meta-regression analyses. There was potential publication bias for the primary composite outcome.
Limitations of the study include 2 studies enrolled some patients without HF and potential treatment modifiers were not evaluated.
“Multiparameter-guided strategy grants a reduction of the composite endpoint of all-cause death and HF hospitalizations, driven by a benefit in both individual components,” the study authors wrote. “Further studies are needed to test the cost-effectiveness of implant-based remote monitoring in guiding the management of HF patients, potentially legitimizing a wide application of such strategy.”
Zito A, Restivo A, Ciliberti G, et al. Heart failure management guided by remote multiparameter monitoring: a meta-analysis. Int J Cardiol. Published online July 8, 2023. doi:10.1016/j.ijcard.2023.131163