In heart failure (HF) patients, remote monitoring using implantable devices may be used to predict and reduce HF exacerbations and mortality. Data from randomized controlled trials (RCTs) was assessed to determine the effectiveness of implantable remote monitoring on the improvement of outcomes in HF patients. A systematic review and meta-analysis of RCTs testing remote monitoring versus standard of care for management of HF patients was performed. Primary endpoints were all-cause mortality and a composite of cardiovascular (CV) and HF hospitalizations. Rate ratios (RRs) and 95% confidence intervals (CI) were calculated. A secondary analysis tested for heterogeneity of treatment effect (HTE) comparing right ventricular/pulmonary pressure monitoring versus impedance-based monitoring on hospitalization. A regression analysis was performed using the mean follow-up time as the moderator on each primary endpoint. Eleven RCTs (n = 6196) were identified with a mean follow-up of 21.9 months. The mean age and reported ejection fraction were 64.1 years and 27.7%, respectively. Remote monitoring did not reduce mortality (RR 0.89 [95% CI 0.77, 1.03]) or the composite of CV and HF hospitalizations (RR 0.98 [0.81, 1.19]). Subgroup analysis found significant HTE for hospitalizations between those studies that used right ventricular/pulmonary pressure monitoring versus impedance-based monitoring (I 2 = 87.1%, chi 2 = 7.75, p = 0.005). Regression analysis found no relationship between the log rate ratio of remote monitoring's effect on mortality, CV hospitalization or HF hospitalization, and mean follow-up time. Compared to standard of care, remote monitoring using implantable devices did not reduce mortality, CV, or HF hospitalizations. However, right ventricular/pulmonary pressure monitoring may reduce HF hospitalizations, which will need to be explored in future studies. Keywords Heart failure • Remote monitoring • Implantable devices • Systematic review • Meta-analysis • Randomized controlled trials Abbreviations HF Heart failure CV Cardiovascular RCT Randomized controlled trial CRT-D Cardiac resynchronization therapy defibrillator ICD Implantable cardioverter-defibrillator Highlights • Standard of care in heart failure outpatient monitoring is centered on patient-reported symptoms. • New methods of monitoring physiologic markers with implantable devices such as cardiac resynchronization therapy device and pulmonary artery pressure sensors have been developed. • Several randomized controlled trials (RCTs) have been conducted examining whether use of remote monitoring has an effect on mortality and hospitalizations. • This systematic review and meta-analysis examined 11 RCTs and showed no significant effect with implantable remote monitoring on mortality, heart failure (HF) hospitalizations, or cardiovascular hospitalizations when compared to standard of care. • A decrease in HF hospitalizations was observed in RCTs using implantable continuous cardiac/pulmonary artery pressure monitoring compared to thoracic impedance-based m...

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Assessment of volume status in hospitalized patients with heart failure is a critically important diagnostic skill that clinicians utilize frequently. However, accurate assessment is challenging and there is often significant inter-provider disagreement. This review serves as an appraisal of current methods of volume assessment amongst different categories of evaluation including patient history, physical exam, laboratory analysis, imaging, and invasive procedures. Within each category, this review highlights methods that are particularly sensitive or specific, or those that carry impactful positive or negative likelihood ratios. Utilization of the information that this review provides will allow clinicians to determine volume status of hospitalized heart failure patients more accurately and more precisely in order to provide appropriate and effective therapies.