Does remote monitoring help in heart failure?

A 2026 meta-analysis of 79 randomised trials and 31,669 patients found that remote monitoring in heart failure reduced all-cause mortality (risk ratio 0.90, 95% CI 0.84 to 0.95) compared with standard care. This is remote monitoring in the broad clinical sense, including phone calls and implanted sensors, not wearables alone.

What counted as remote monitoring in these trials?

The review by Scholte and colleagues in npj Digital Medicine pooled trials of five kinds of remote monitoring: telemonitoring (biometric data or symptom questionnaires sent to a clinic), structured telephone support, combined telemonitoring with coaching, monitoring through implanted cardiac devices, and invasive haemodynamic monitoring (implanted pressure sensors). Consumer wearables are not a separate category in it.

Overall, remote monitoring reduced total heart failure hospitalisations (incidence rate ratio 0.81, 95% CI 0.72 to 0.91) and first hospitalisations (risk ratio 0.82, 95% CI 0.76 to 0.88). Mean follow-up was 12 months, ranging from 1 to 45 months.

Not every modality contributed equally. In the network comparison, invasive haemodynamic monitoring ranked highest for total hospitalisations. Structured telephone support ranked highest for first hospitalisations and for mortality, and it was the only modality with a statistically significant mortality reduction (risk ratio 0.76, 95% CI 0.65 to 0.88).

Who benefits most, and what is still unknown?

That is the open gap. Subgroup and meta-regression analyses covered age, ejection fraction, symptom class, sex, region and publication year, and found consistent benefit without significant interactions. The authors conclude that current evidence does not allow remote monitoring to be targeted at the patients most likely to benefit.

There are also caveats. Only 3 of the 79 trials compared monitoring strategies head to head, so most comparisons between modalities are indirect. Certainty was rated moderate for most comparisons, funnel plots suggested possible publication bias, and the trials span 1999 to 2025, a period in which standard heart failure treatment changed. The authors also note that they could not calculate absolute effects for subgroups, so these are relative figures.

For the consumer-device side of the question, see wearables that detect illness early.

The bottom line

• Across 79 randomised trials (31,669 patients), remote monitoring was associated with lower all-cause mortality (risk ratio 0.90) and fewer heart failure hospitalisations (incidence rate ratio 0.81).
• The evidence covers phone support, telemonitoring and implanted sensors, not consumer wearables as a category.
• The review could not identify which patients benefit most, and much of the comparison between modalities is indirect.