Telemonitoring modalities in heart failure: comparative effectiveness across the heart failure population—a meta-analysis

Remote monitoring (RM) is effective for managing heart failure (HF), but it remains unclear which patients benefit most from which RM modality. We conducted a meta-analysis of 79 randomised trials including 31,669 patients comparing RM with standard care for total and first HF hospitalisations and all-cause mortality. Subgroup analyses evaluated effects by geographic region and HF status, and meta-regression assessed the influence of age, left ventricular ejection fraction, New York Heart Association class, sex, and publication year. Network meta-analysis ranked RM modalities using Surface Under the Cumulative Ranking scores. Overall, RM reduced total HF hospitalisations (incidence rate ratio 0.81, 95% confidence interval [CI] 0.72-0.91), first HF hospitalisations (risk ratio 0.82, 95% CI: 0.76-0.88), and all-cause mortality (risk ratio 0.90, 95% CI: 0.84-0.95). Subgroup and meta-regression analyses showed consistent benefits across patient and study characteristics without significant interaction effects. In network meta-analysis, invasive hemodynamic monitoring ranked highest for reducing total HF hospitalisations, while structured telephone support ranked highest for reducing first HF hospitalisation and all-cause mortality. RM consistently improves HF outcomes across a range of patient and study characteristics, supporting its broad use. However, based on these characteristics, current evidence does not allow targeted RM implementation for specific patients most likely to benefit.