Remote patient monitoring significantly reduced all-cause mortality (RR 0.911; 95% CI 0.842-0.985; P=0.021) and heart failure hospitalization compared with usual care.
Meta-Analysis (n=23,000)
Does remote patient monitoring reduce all-cause mortality and HF hospitalization in patients with heart failure compared with usual care?
Remote patient monitoring across diverse modalities significantly reduces all-cause mortality and heart failure hospitalizations compared to usual care.
Effect estimate: RR 0.911 (95% CI 0.842-0.985)
p-value: p=0.021
Whether the cumulative evidence for remote patient monitoring (RPM) in heart failure (HF) is robust to sequential monitoring, and whether trials report geographic access modifiers, remains uncertain. We conducted a systematic review, meta-analysis, and trial sequential analysis (TSA) of 65 randomized controlled trials (RCTs) (59 poolable; approximately 23,000 participants) identified through a search of PubMed/MEDLINE, Cochrane CENTRAL, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform (ICTRP) from inception through February 15, 2026, encompassing structured telephone support (STS) (15 trials), non-invasive telemonitoring (TM) (33 trials), and invasive hemodynamic monitoring (11 trials). Random-effects meta-analysis used restricted maximum likelihood (REML) with the Hartung-Knapp-Sidik-Jonkman (HKSJ) adjustment, and certainty of evidence was rated using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework. RPM significantly reduced all-cause mortality (ACM) (risk ratio (RR): 0.911, 95% confidence interval (CI): 0.842-0.985; P=0.021; I²=0%; k=41; number needed to treat (NNT) 104 per year; prediction interval: 0.840-0.988), and trial sequential analysis suggested that the accrued evidence exceeded the required information size under a 15% relative risk reduction assumption, supporting a stable mortality signal. HF hospitalization was reduced (RR: 0.781, 95% CI: 0.710-0.859; P<0.001; k=39; number needed to treat 18 per year), although the prediction interval crossed 1.0 (0.586-1.040), indicating that in some clinical settings, the effect may be attenuated. All-cause hospitalization was not significantly reduced (RR: 0.959, 95% CI: 0.892-1.031; k=28). No statistically significant interaction by RPM modality was detected for any primary outcome (all-cause mortality P-interaction=0.80; HF hospitalization P-interaction=0.14). GRADE certainty was moderate for all-cause mortality and low for HF hospitalization, downgraded primarily for suspected publication bias and inconsistency. A descriptive geographic access analysis revealed that only 2 of 59 poolable trials reported formal rural-versus-urban subgroup analyses, precluding firm conclusions about whether RPM differentially benefits geographically underserved populations. Within these limitations, remote patient monitoring appears to reduce all-cause mortality and HF hospitalization compared with usual care across diverse modalities, while signaling persistent gaps in heterogeneity reporting and equity-focused subgroup data.
Ferreira et al. (Tue,) conducted a meta-analysis in Heart failure (n=23,000). Remote patient monitoring vs. Usual care was evaluated on All-cause mortality (RR 0.911, 95% CI 0.842-0.985, p=0.021). Remote patient monitoring significantly reduced all-cause mortality (RR 0.911; 95% CI 0.842-0.985; P=0.021) and heart failure hospitalization compared with usual care.