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Remote monitoring of implantable cardiac devices in heart failure patients: a systematic review and meta-analysis of randomized controlled trials

  • Sultan Alotaibi
  • Jaime Hernandez-Montfort
  • Omar E. Ali
  • Karim El-Chilali
  • Bernardo A. PerezEmail author
Article

Abstract

This study aims to determine whether the use of remote monitoring (RM) in implantable cardiac devices decreases all-cause mortality and heart failure (HF)-related hospitalization. We sought to conduct a systematic review and a meta-analysis of published randomized controlled studies. The population is adult patients with a diagnosis of HF with implantable devices. The intervention is RM using implantable cardiac devices whether added or used alone compared to standard of care. The outcomes are HF-related hospitalization and all-cause mortality. Risk of bias was assessed using the criteria defined in the Revised Cochrane Collaboration’s tool for assessment of risk of bias. Data were extracted and validity was assessed independently by two reviewers. Electronic databases EMBASE and MEDLINE (Ovid) were searched up to 14th of October 2019, supplemented by a second search in CENTRAL (Cochrane Central Register of Controlled Trials) and clinicaltrials.gov. Only randomized controlled studies published in peer-reviewed journals with full format text in English of adult HF patients with a minimum follow-up of 6 months reporting mortality and/or hospitalization. Observational studies and studies that did not meet inclusion criteria were excluded. Thirteen randomized controlled studies that enrolled a total of 7015 patients were identified, 7 of which reported on all-cause mortality only and included 4460 patients. Compared with standard of care, the pooled relative risk (RR) of all-cause mortality and HF-related hospitalization in patients with RM compared to those receiving standard of care was 0.88 (95% confidence interval (CI) 0.69 to 1.11) and 0.95 (95% CI 0.78–1.16), respectively. In the subgroup analysis, using pulmonary pressure for RM was associated with a decrease in HF-related hospitalization (RR 0.73; 95% CI 0.60–0.88). RM showed benefit in reducing HF-related hospitalization when compared to standard of care only when using pulmonary pressure monitoring.

Keywords

Haemodynamic monitoring Heart failure Hospitalizations Mortality Meta-analysis 

Notes

Acknowledgements

We would like to thank Yang Chen and Mario Santos for their comments on a previous version of this paper as well on the search strategy.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

10741_2020_9923_MOESM1_ESM.docx (424 kb)
ESM 1 (DOCX 423 kb)

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2020

Authors and Affiliations

  1. 1.Cardiac CenterKing Fahad Armed Forces HospitalJeddahSaudi Arabia
  2. 2.Department of Health PolicyLondon School of Economics and Political ScienceLondonUK
  3. 3.Cleveland Clinic FloridaWestonUSA
  4. 4.School of MedicineWayne State UniversityDetroitUSA
  5. 5.Medical Director of Cardiac Catheterization LaboratoryDetroit Medical CenterDetroitUSA
  6. 6.Department of Cardiovascular and Pulmonary MedicineProsper HospitalRecklinghausenGermany
  7. 7.Wellian Inc.BoulderUSA

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