The Impact of Remote Patient Monitoring on Clinical Outcomes in Heart Failure Patients: A Meta-Analysis

Remote patient monitoring (RPM) is increasingly used in heart failure (HF) management, but its clinical impact varies across studies. This systematic review and meta-analysis included 15 primary studies (nine randomized controlled trials and six observational cohorts) evaluating RPM effects on hospitalizations, mortality, and quality of life (QoL). In pooled analyses, RPM reduced HF-related hospitalizations (risk ratio (RR) = 0.80, 95% CI: 0.77-0.84, p < 0.0001). Implantable hemodynamic monitoring devices (e.g., pulmonary artery pressure sensors and cardiac implantable electronic devices) showed larger effects (RR = 0.72, 95% CI: 0.70-0.75) compared with noninvasive RPM modalities (e.g., telemonitoring, mobile apps; RR = 0.83, 95% CI: 0.81-0.86; p < 0.0001 for subgroup interaction). Mortality reduction was small but statistically significant (RR = 0.92, 95% CI: 0.90-0.94, p < 0.05), with implantable devices slightly stronger (RR = 0.90, 95% CI: 0.87-0.93) than noninvasive modalities (RR = 0.93, 95% CI: 0.91-0.96; p = 0.0074 for subgroup interaction). QoL showed a small, consistent improvement (standardized mean difference = 0.23, 95% CI: 0.20-0.26, p < 0.05) across MLHFQ and KCCQ instruments. Funnel plots and Egger's regression indicated no publication bias for hospitalization (p = 0.45) or mortality (p = 0.62). Heterogeneity was low (I² = 0%, τ² = 0), with narrow prediction intervals. GRADE certainty was moderate for hospitalization and QoL and low for mortality. RPM, particularly implantable monitoring, reduces HF hospitalizations and improves QoL, with modest mortality benefits needing further confirmation. Implementation should target high-risk patients (NYHA III-IV and recent hospitalization), with future research on long-term survival, cost-effectiveness, and equitable access.