Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, Rome, Italy.
Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy.
Eur J Heart Fail. 2022 Dec;24(12):2333-2341. doi: 10.1002/ejhf.2655. Epub 2022 Sep 11.
Pre-clinical congestion markers of worsening heart failure (HF) can be monitored by devices and may support the management of patients with HF. We aimed to assess whether congestion-guided HF management according to device-based remote monitoring strategies is more effective than standard therapy.
A comprehensive literature research for randomized controlled trials (RCTs) comparing device-based remote monitoring strategies for congestion-guided HF management versus standard therapy was performed on PubMed, Embase, and CENTRAL databases. Incidence rate ratios (IRRs) and associated 95% confidence intervals (CIs) were calculated using the Poisson regression model with random study effects. The primary outcome was a composite of all-cause death and HF hospitalizations. Secondary endpoints included the individual components of the primary outcome. A total of 4347 patients from eight RCTs were included. Findings varied according to the type of parameters monitored. Compared with standard therapy, haemodynamic-guided strategy (4 trials, 2224 patients, 12-month follow-up) reduced the risk of the primary composite outcome (IRR 0.79, 95% CI 0.70-0.89) and HF hospitalizations (IRR 0.76, 95% CI 0.67-0.86), without a significant impact on all-cause death (IRR 0.93, 95% CI 0.72-1.21). In contrast, impedance-guided strategy (4 trials, 2123 patients, 19-month follow-up) did not provide significant benefits.
Haemodynamic-guided HF management is associated with better clinical outcomes as compared to standard clinical care.
可以通过设备监测到恶化心力衰竭（HF）的临床前充血标志物，这可能有助于 HF 患者的管理。我们旨在评估基于设备的远程监测策略指导充血的 HF 管理是否比标准治疗更有效。
在 PubMed、Embase 和 CENTRAL 数据库中进行了全面的文献检索，以评估比较基于设备的远程监测策略指导充血的 HF 管理与标准治疗的随机对照试验（RCT）。使用具有随机研究效应的泊松回归模型计算发生率比（IRR）和相关的 95％置信区间（CI）。主要结局是全因死亡和 HF 住院的复合结局。次要终点包括主要结局的各个组成部分。共纳入了来自 8 项 RCT 的 4347 名患者。研究结果因监测参数的类型而异。与标准治疗相比，血流动力学指导策略（4 项试验，2224 名患者，12 个月随访）降低了主要复合结局的风险（IRR 0.79，95％CI 0.70-0.89）和 HF 住院（IRR 0.76，95％CI 0.67-0.86），但对全因死亡无显著影响（IRR 0.93，95％CI 0.72-1.21）。相比之下，阻抗指导策略（4 项试验，2123 名患者，19 个月随访）并未提供显著益处。
与标准临床护理相比，血流动力学指导的 HF 管理与更好的临床结局相关。
