Previous studies have reported contradictory findings on the utility of remote physiological monitoring (RPM)-guided management of patients with chronic heart failure (HF). Multiple databases were searched for studies that evaluated the clinical efficacy of RPM-guided management versus standard of care (SOC) for HF patients. The primary outcome was HF-related hospitalization (HFH). The secondary outcomes were all-cause mortality, cardiovascular-related (CV) mortality, and emergency department (ED) visits. Pooled relative risk (RR) and corresponding 95% confidence intervals (CIs) were calculated and combined using a random-effects model. A total of 16 randomized controlled trials, including 8679 HF patients (4574 managed with RPM-guided therapy vs. 4105 managed with SOC), were included in the final analysis. The average follow-up period was 15.2 months. There was no significant difference in HFH rate between the two groups (RR: 0.94; 95% CI: 0.84–1.07; P = 0.36). Similarly, there were no significant differences in CV mortality (RR 0.86, 95% CI 0.73–1.02, P = 0.08) or in ED visits (RR 0.80, 95% CI 0.59–1.08, P = 0.14). However, RPM-guided therapy was associated with a borderline statistically significant reduction in all-cause mortality (RR: 0.88; 95% CI: 0.78–1.00; P = 0.05). Subgroup analysis based on the strategy of RPM showed that both hemodynamic and arrhythmia telemonitoring–guided management can reduce the risk of HFH (RR: 0.79; 95% CI: 0.64–0.97; P = 0.02) and (RR: 0.79; 95% CI: 0.67–0.94; P = 0.008) respectively. Our study demonstrated that RPM-guided diuretic therapy of HF patients did not reduce the risk of HFH but can improve survival. Hemodynamic and arrhythmia telemonitoring–guided management could reduce the risk of HF-related hospitalizations.

以前的研究报告了关于远程生理监测 (RPM) 指导的慢性心力衰竭 (HF) 患者管理效用的相互矛盾的发现。在多个数据库中搜索了评估 RPM 指导管理与治疗标准 (SOC) 对 HF 患者的临床疗效的研究。主要结局是心衰相关住院（HFH）。次要结局是全因死亡率、心血管相关 (CV) 死亡率和急诊科 (ED) 就诊。使用随机效应模型计算和组合汇总的相对风险 (RR) 和相应的 95% 置信区间 (CI)。最终分析包括 16 项随机对照试验，包括 8679 名 HF 患者（4574 名使用 RPM 引导治疗管理，4105 名使用 SOC 管理）。平均随访时间为 15 天。2个月。两组 HFH 发生率无显着差异（RR：0.94；95% CI：0.84-1.07；P  = 0.36）。同样，CV 死亡率（RR 0.86，95% CI 0.73–1.02， P  = 0.08）或 ED 就诊（RR 0.80，95% CI 0.59–1.08，P  = 0.14）没有显着差异。然而，RPM 指导的治疗与全因死亡率的临界统计学显着降低相关（RR：0.88；95% CI：0.78-1.00；P  = 0.05）。基于 RPM 策略的亚组分析表明，血流动力学和心律失常远程监测指导的管理可以降低 HFH 的风险（RR：0.79；95% CI：0.64-0.97；P  = 0.02）和（RR：0.79；95% CI : 0.67–0.94; P = 0.008) 分别。我们的研究表明，对 HF 患者进行 RPM 引导的利尿剂治疗并不能降低 HFH 的风险，但可以提高生存率。血流动力学和心律失常远程监测指导的管理可以降低与心衰相关的住院风险。