Heart failure (HF) affects approximately 64 million people worldwide and has a growing incidence. Telemonitoring programs, that use information communication technology for remotely monitoring patients, may be the next breakthrough in HF care management. Evaluations in real-world settings of monitoring systems and solutions on overall survival in HF are limited.

The objective of this study was to examine the association between a remote monitoring program (RMP) and all-cause mortality in HF within the French healthcare system.

A national-scale, real-world, propensity-weighted cohort study was conducted using the SNDS French database from August 2018 to December 2022 (NCT06312501). We compared patients only receiving standard of care (SoC) to those receiving RMP (Satelia® Cardio, NP Medical) and SoC. The Satelia® Cardio algorithm adjusted the monitoring frequency based on symptom and weight changes, and provided tailored patient education. The system facilitated phone monitoring by nurses for those uncomfortable to use electronic devices, and had a standard digital interface for those digitally proficient. Data were sourced from over 300 healthcare centers across France. The primary outcome was all-cause mortality. We employed a propensity-weighted Cox regression model supplemented by sensitivity analyses across subgroups.

In total, 5357 RMP patients and 13,525 SoC patients were included after weighting. Mortality was 15.7% in the RMP group versus 25.3% in the SoC group. The adjusted analysis revealed a lower all-cause mortality for patients using RMP (HR=0.64; 95% CI [0.59 to 0.70]; P<0.0001). The reduction in mortality was more pronounced in patients with no/poor digital literacy receiving phone monitoring (HR=0.54; 95% CI [0.48 to 0.60]) compared to digitally literate patients using the web application (HR=0.67; 95% CI [0.60 to 0.74]; P for interaction 0.006) (Figure 1).

RMP with customized monitoring frequencies and educational strategies can lower all-cause mortality, particularly among patients less comfortable with electronic devices. This finding underscores the potential for RMPs to enhance nationwide HF management.