Remote patient monitoring in heart failure: a comprehensive meta-analysis and systematic review analyzing efficacious program components for hospitalization reduction
Authors: Nieuwenhuys W W , De Lathauwer I L J , Regis M , Hafkamp F J , Brouwers R W M , Funk M , Kemps H M C 
Published: June 2024

Abstract

Background and Purpose
Methods of noninvasive Remote Patient Monitoring (RPM) for heart failure remain diverse. More insight into the factors determining effects of RPM programs is necessary to provide clinicians and researchers with a blueprint for developing and implementing successful RPM systems. The objective of this systematic review is to comprehensively evaluate and synthesize existing literature on components of RPM programs that mediate effects on hospital (re-)admission and mortality in heart failure (HF) patients.

Methods
A systematic search of electronic databases (PubMed, EMBASE, Central) was conducted, including randomized controlled trails, comparing a non-invasive RPM strategy for HF patients against usual care (UC), published between January 2012 and June 2023. To enhance inclusivity, the search was supplemented by articles used in the latest meta-analysis on RPM. Through this synergy articles spanning the past 27 years have been reviewed. A random-effects meta-analysis was performed comparing UC with RPM. HF-rehospitalisation, mortality, all-cause rehospitalisation and emergency department visits were used as study endpoints. Multiple meta-regressions and sub-group analyses were performed to further identify which components of RPM are effective in management of HF patients. Components analysed were as follows: monitoring frequency, communication modality, intended goal, vital parameters, and caregiver contact.

Results
A total of forty-one studies were included, enrolling a total of 16512 patients with a mean follow-up time of 10.13 months. Patients using RPM had a significantly lower mortality (pooled OR: 0.81 CI: 0.69-0.95 I²:0.39) and HF-rehospitalisation (Pooled OR: 0.78 CI: 0.70-0.87 I²: 0.21). A monitoring frequency of at least once a day vs less than once a day affected mortality, the former causing a significant decrease in mortality (Pooled OR: 0.80 IC: 0.66-0.98 I²: 0.36) while the latter did not show this same significant decrease (Pooled OR: 0.80 IC: 0.55-1.14 I²: 0.46). Blood pressure monitoring had significantly lower HF-rehospitalisation (Pooled OR: 0.74 IC: 0.64-0.86 I²: 0.15). Strategies where blood pressure was not measured did not show this same significant decrease (Pooled OR: 0.85 IC: 0.72-1.01 I²: 0.36) Monitoring including video calls was associated with a lower risk at all-cause rehospitalisations (Pooled OR: 0.35 IC: 0.25-0.51 I²: 0.00 versus pooled OR: 1.01 IC: 0.92-1.10 I²: 0.18). Due to small numbers and a remain high heterogeneity in strategies between studies, conclusions on other components could not be drawn.

Conclusions
These results support implementation of RPM to reduce HF-related readmissions and mortality. Components that were associated with a bigger effect on various endpoints were monitoring frequency of at least once a day, inclusion of blood pressure monitoring and use of video calls. However, differences in strategies between studies remains large. PRISMA Flowchart Forest Plot HF-Rehospitalisations