Economic Evaluations of Invasive Devices for Remote Cardiac Monitoring in Chronic Heart Failure: A Scoping Review

OBJECTIVES: Heart failure presents a substantial global clinical and economic burden. While invasive hemodynamic and device-based remote monitoring effectively guide its management, their economic value across diverse healthcare systems remains incompletely characterized. This scoping review evaluates the cost-effectiveness of these distinct monitoring strategies. DESIGN AND METHODS: Following established scoping-review reporting guidelines, we searched PubMed and Scopus (March 2026) for original peer-reviewed economic evaluations (for example, cost-effectiveness or cost-utility analyses) of invasive cardiac monitoring or cardiac implantable electronic device remote monitoring in adult heart failure patients. RESULTS: Nineteen studies across 11 countries were included, divided into two categories: standalone invasive sensors (predominantly CardioMEMS, ten studies) and cardiac implantable electronic device remote monitoring (nine studies), the latter spanning standard platforms and advanced alerts (HeartLogic, TriageHF Plus). The first category showed pulmonary pressure-guided monitoring is cost-effective in high-income settings (United Kingdom, continental Europe, United States), though device pricing exceeded cost-effectiveness thresholds in Argentina. The second category consistently showed cost-neutral or cost-saving outcomes compared with in-office follow-up, with the largest savings in resynchronization-defibrillator recipients. Advanced alert algorithms showed highly favorable economic profiles, although both lacked ideal comparators testing identical device platforms with the algorithm deactivated. These findings align with recent national health-technology guidance recommending both technologies. CONCLUSIONS: Both technologies are economically advantageous for heart failure management across multiple healthcare systems. Future research should prioritize standardized health-economic modeling, explicit separation of technology subcategories with distinct comparators, randomized algorithm-on versus algorithm-off designs, and dedicated evaluations in low- and middle-income countries to guide equitable global deployment.