Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy.
Department of Translational and Precision Medicine, Sapienza - University of Rome, Rome, Italy.
Int J Cardiol. 2023 Oct 1;388:131163. doi: 10.1016/j.ijcard.2023.131163. Epub 2023 Jul 8.
Several implant-based remote monitoring strategies are currently tested to optimize heart failure (HF) management by anticipating clinical decompensation and preventing hospitalization. Among these solutions, the modern implantable cardioverter-defibrillator and cardiac resynchronization therapy devices have been equipped with sensors allowing continuous monitoring of multiple preclinical markers of worsening HF, including factors of autonomic adaptation, patient activity, and intrathoracic impedance.
We aimed to assess whether implant-based multiparameter remote monitoring strategy for guided HF management improves clinical outcomes when compared to standard clinical care.
A systematic literature research for randomized controlled trials (RCTs) comparing multiparameter-guided HF management versus standard of care 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 hospitalization events, whereas secondary endpoints included the individual components of the primary outcome.
Our meta-analysis included 6 RCTs, amounting to a total of 4869 patients with an average follow-up time of 18 months. Compared with standard clinical management, the multiparameter-guided strategy reduced the risk of the primary composite outcome (IRR 0.83, 95%CI 0.71-0.99), driven by statistically significant effect on both HF hospitalization events (IRR 0.75, 95%CI 0.61-0.93) and all-cause death (IRR 0.80, 95%CI 0.66-0.96).
Implant-based multiparameter remote monitoring strategy for guided HF management is associated with significant benefit on clinical outcomes compared to standard clinical care, providing a benefit on both hospitalization events and all-cause death.
目前正在测试几种基于植入物的远程监测策略，以通过预测临床失代偿和预防住院来优化心力衰竭（HF）管理。在这些解决方案中，现代植入式心脏复律除颤器和心脏再同步治疗设备已配备了传感器，可连续监测多个HF 恶化的临床前标志物，包括自主适应、患者活动和胸腔内阻抗等因素。
我们旨在评估基于植入物的多参数远程监测策略用于指导 HF 管理是否与标准临床护理相比可改善临床结局。
我们在 PubMed、Embase 和 CENTRAL 数据库中进行了系统的随机对照试验（RCT）文献检索，比较了多参数指导的 HF 管理与标准护理。使用具有随机研究效果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 住院事件的复合结局，而次要结局包括主要结局的各个组成部分。
我们的荟萃分析包括 6 项 RCT，共计 4869 例患者，平均随访时间为 18 个月。与标准临床管理相比，多参数指导策略降低了主要复合结局的风险（IRR 0.83，95%CI 0.71-0.99），这主要归因于 HF 住院事件（IRR 0.75，95%CI 0.61-0.93）和全因死亡（IRR 0.80，95%CI 0.66-0.96）的发生率显著降低。
与标准临床护理相比，基于植入物的多参数远程监测策略用于指导 HF 管理可显著改善临床结局，对住院事件和全因死亡均有益。
