Systematic review and meta-analysis shows remote monitoring reduces mortality and hospitalizations in heart failure

Whether the cumulative evidence for remote patient monitoring (RPM) in heart failure (HF) is robust to sequential monitoring, and whether trials report geographic access modifiers, remains uncertain. We conducted a systematic review, meta-analysis, and trial sequential analysis (TSA) of 65 RCTs (59 poolable; ~23,000 participants) across four databases through February 2026, encompassing structured telephone support (15 trials), non-invasive telemonitoring (33), and invasive hemodynamic monitoring (11). Random-effects meta-analysis used REML with Hartung-Knapp-Sidik-Jonkman adjustment. RPM significantly reduced all-cause mortality (RR 0.911, 95% CI 0.842-0.985; P=0.021; I2=0%; k=41; NNT 104/year; prediction interval 0.840-0.988). TSA suggested that accrued evidence exceeded the required information size under the 15% relative risk reduction assumption, supporting a stable mortality signal. HF hospitalization was reduced (RR 0.781, 95% CI 0.710-0.859; P<0.001; k=39; NNT 18/year), though the prediction interval crossed 1.0 (0.586-1.040), indicating that in some settings the effect may be attenuated. No statistically significant interaction by RPM type was detected (all-cause mortality Pinteraction=0.80; HF hospitalization Pinteraction=0.14). GRADE certainty was moderate for mortality and low for HF hospitalization. A descriptive geographic access analysis revealed that only 2 of 59 poolable trials reported formal rural/urban subgroups, precluding conclusions about whether RPM differentially benefits underserved populations.