Postdischarge Remote Monitoring Methods for Patients with Chronic Heart Failure: A Systematic Review of the Main Techniques and Meta-analysis

BACKGROUND: Heart failure (HF) is a growing global health challenge with high morbidity and mortality. Remote monitoring has emerged as a potential tool to improve outcomes, particularly in reducing hospitalizations and mortality. However, the comparative effectiveness of noninvasive versus invasive strategies remains unclear. AREAS OF UNCERTAINTY: Despite the increasing use of telemedicine in HF management, uncertainties remain regarding its long-term impact, the role of patient adherence, and the effectiveness of specific technologies across different patient populations. DATA SOURCES: We conducted a systematic search of PubMed and the Cochrane Library for studies published between January 1, 1994, and February 1, 2025. Eligible studies included randomized controlled trials and observational studies assessing the impact of remote monitoring interventions on mortality, hospitalizations, adherence, and quality of life in patients with HF. RESULTS: A total of 105 studies (85 randomized controlled trials and 19 observational) with 45,072 patients were included. Noninvasive remote monitoring, particularly structured telephone support, was associated with significant reductions in both all-cause mortality (P = 0.005) and HF hospitalizations (P < 0.0001). Telemonitoring also reduced hospitalizations but had limited mortality benefits. Invasive hemodynamic monitoring showed a significant reduction in hospitalizations (P < 0.00001), whereas cardiac implantable electronic devices demonstrated a nonsignificant trend toward reduced mortality (P = 0.14). Quality-of-life improvements were reported more frequently in noninvasive studies. Studies varied widely in methodology, monitoring protocols, and patient populations, contributing to moderate-to-high heterogeneity. CONCLUSIONS: Remote monitoring, particularly noninvasive strategies, is associated with improved outcomes in HF care. Structured telephone support showed the most consistent benefits. Invasive techniques may be valuable in selected patients, although further studies are needed, particularly in populations receiving contemporary guideline-directed medical therapy. Integration of artificial intelligence and improved adherence strategies may enhance future telemonitoring effectiveness.