Impact of remote monitoring on clinical outcomes in patients with cardiac implantable electronic devices: a systematic review and meta-analysis
M J Primo, L G Rocha, G T Batista, N Antonio, R Bertao Ventura, D Martinez, I Brito Cruz, L GoncalvesAbstract
Introduction
Remote monitoring (RM) of cardiac implantable electronic devices (CIEDs) has gained increasing attention as a strategy to improve the management of patients with heart failure (HF). By enabling early identification of physiological deterioration and arrhythmic events, RM has the potential to facilitate timely clinical interventions. Nonetheless, evidence from randomized controlled trials (RCTs) regarding its effect on HF hospitalizations and cardiovascular (CV) mortality remains inconsistent. This systematic review and meta-analysis sought to assess the impact of RM, compared with usual care (UC), on HF-related hospitalizations and CV mortality in patients with CIEDs.
Methods
A comprehensive systematic search of PubMed, Embase, and the Cochrane Library was performed to identify RCTs published between January 2019 and June 2025. Eligible studies enrolled adult recipients of CIEDs, compared RM with UC, and reported outcomes related to HF hospitalizations or CV mortality. Data extraction included sample size, baseline patient characteristics, duration of follow-up, and event rates in both study groups. Given the absence of statistical heterogeneity, pooled effect estimates were calculated using a fixed-effects Mantel–Haenszel model.
Results
Four RCTs encompassing a total of 2,383 patients were included, with 1,268 patients assigned to RM and 1,115 to UC. Across studies, participants had advanced HF, with mean left ventricular ejection fractions ranging from 26.5% to 30%, a predominance of male patients (79–90%), and follow-up durations between 1 and 24 months. RM was associated with a significant reduction in HF hospitalizations compared with UC (odds ratio [OR] 0.77; 95% confidence interval [CI] 0.63–0.94; p = 0.009), with no observed heterogeneity (I² = 0%). A total of 249 HF hospitalizations occurred in the RM group versus 298 in the UC group. Conversely, RM did not significantly reduce CV mortality (OR 0.92; 95% CI 0.58–1.44; p = 0.71), again with no evidence of heterogeneity (I² = 0%).
Conclusion
In patients with CIEDs, RM is associated with a significant reduction in HF hospitalizations but does not translate into a measurable short-term reduction in CV mortality. These findings suggest that the primary benefit of RM lies in mitigating HF decompensation rather than modifying mortality outcomes, highlighting the need for longer follow-up periods and more standardized RM implementation strategies.For image description, please refer to the figure legend and surrounding text.For image description, please refer to the figure legend and surrounding text.