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QUARTERLY FOCUS ISSUE: HEART FAILURE: CLINICAL RESEARCH

A Meta-Analysis of Remote Monitoring of Heart Failure Patients

Catherine Klersy, MD, MSc^_*,_*, Annalisa De Silvestri, MSc^_*, Gabriella Gabutti, MA, François Regoli, MD^_*, and Angelo Auricchio, MD

^_* Service of Biometry and Clinical Epidemiology, Scientific Direction Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
Scientific Documentation Center, Scientific Direction Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland

Manuscript received May 25, 2009; revised manuscript received August 31, 2009, accepted August 31, 2009.

^_* Reprint requests and correspondence: Dr. Catherine Klersy, Servizio di Biometria ed Epidemiologia Clinica, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy (Email: klersy{at}smatteo.pv.it).

Objectives: The purpose of this study was to assess the effect of remote patient monitoring (RPM) on the outcome of chronic heart failure (HF) patients.

Background: RPM via regularly scheduled structured telephone contact between patients and health care providers or electronic transfer of physiological data using remote access technology via remote external, wearable, or implantable electronic devices is a growing modality to manage patients with chronic HF.

Methods: After a review of the literature published between January 2000 and October 2008 on a multidisciplinary heart failure approach by either usual care (in-person visit) or RPM, 96 full-text articles were retrieved: 20 articles reporting randomized controlled trials (RCTs) and 12 reporting cohort studies qualified for a meta-analysis.

Results: Respectively, 6,258 patients and 2,354 patients were included in RCTs and cohort studies. Median follow-up duration was 6 months for RCTs and 12 months for cohort studies. Both RCTs and cohort studies showed that RPM was associated with a significantly lower number of deaths (RCTs: relative risk [RR]: 0.83, 95% confidence interval [CI]: 0.73 to 0.95, p = 0.006; cohort studies: RR: 0.53, 95% CI: 0.29 to 0.96, p < 0.001) and hospitalizations (RCTs: RR: 0.93, 95% CI: 0.87 to 0.99, p = 0.030; cohort studies: RR: 0.52, 95% CI: 0.28 to 0.96, p < 0.001). The decrease in events was greater in cohort studies than in RCTs.

Conclusions: RPM confers a significant protective clinical effect in patients with chronic HF compared with usual care.

Key Words: device-based monitoring • heart failure • meta-analysis • remote monitoring • outcome

Abbreviations and Acronyms   CI = confidence interval   HF = heart failure   RCT = randomized controlled trial   RPM = remote patient monitoring   RR = relative risk

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