Remote Monitoring Interventions in Chronic Heart Failure: A Comprehensive Systematic Review and Network Meta-Analysis of Randomized Controlled Trials, with Trial Sequential Analysis and GRADE Assessment
DOI:
https://doi.org/10.47363/h3qx2n24Keywords:
Chronic Heart Failure, Remote Monitoring, Implantable Pulmonary Artery Pressure, AI-Assisted Management, Telemonitoring, Network Meta-Analysis, Heart Failure Hospitalization MortalityAbstract
Background: Chronic Heart Failure (CHF) affects over 64 million people globally, with high hospitalization rates and 5-year mortality comparable to many cancers. Remote monitoring Strategies-Structured Telephone Support (STS), Non-Invasive Telemonitoring (NIT), Wearable Sensors (WMS), implantable pulmonary artery pressure sensors (IPAP), AI-Assisted Integrated Remote Management (AI-IRM), and Combined Multimodal Programs (CMP)-have been widely studied, but their comparative effectiveness has not been systematically assessed in a Network Meta-Analysis (NMA).
Methods and Findings: We systematically searched multiple databases through 15 December 2025. Primary outcomes were all-cause mortality and HF hospitalization; secondary outcomes included cardiovascular mortality, quality of life, exercise capacity, NT-proBNP, NYHA class, and cost-effectiveness. Two reviewers screened studies, extracted data, and assessed risk of bias using RoB 2; certainty was rated with GRADE. We identified 112 RCTs enrolling 68,420 patients across 34 countries. IPAP ranked highest for mortality (SUCRA 87%; RR 0.80, 95% CI 0.70–0.91, moderate certainty) and HF hospitalization (SUCRA 91%; RR 0.65, 95% CI 0.56–0.75, high certainty). AI-IRM ranked second for both outcomes (mortality SUCRA 74%; RR 0.83, 95% CI 0.73–0.94, low certainty; HF hospitalization SUCRA 79%; RR 0.72, 95% CI 0.63–0.82, moderate certainty). STS and NIT provided modest, low-certainty reductions (RR 0.88–0.90). Trial sequential analysis confirmed conclusive evidence for IPAP. Network consistency was acceptable (Q_inc P = 0.21).
Conclusions: IPAP offers the most robust and clinically meaningful benefit for HFrEF patients. AI-IRM is a promising emerging approach requiring confirmatory trials. STS and NIT remain appropriate for patient’s ineligible for advanced monitoring. Evidence gaps in HFpEF and in low- and middleincome settings define key priorities for future research.
