Remote Patient Monitoring in Heart Failure

Abstract

Background: Heart failure (HF) remains a major public health burden, accounting for approximately one million hospitalizations annually in the United States, with nearly 20% of patients readmitted within 30 days. Remote patient monitoring (RPM), using connected devices and telehealth platforms, has emerged as a promising approach to detect early signs of decompensation, improve adherence to guideline-directed therapy, and reduce recurrent hospitalizations. Recent large-scale trials and real-world studies have evaluated RPM’s effects on clinical outcomes, patient-reported quality of life, and mortality.

Methods: We reviewed recent data from randomized and real-world studies examining the impact of RPM on HF management. The MONITOR-HF trial (Lancet 2023) enrolled approximately 340 patients with NYHA class III HF, comparing implantable pulmonary-artery pressure–guided management with usual care. The E-INH trial (JACC HF 2023) evaluated a nurse-coordinated, telephone-based RPM program in 1,022 post-discharge patients with reduced ejection fraction, extending follow-up to ten years. Additionally, a prospective ACO cohort (2021–2022) implemented a short-term home RPM program using daily vital sign and symptom tracking in high-risk HF patients after discharge.

Results: In MONITOR-HF, RPM significantly reduced HF events compared with standard care (hazard ratio [HR] 0.56; p=0.0053) and improved health-related quality of life, reflected by a mean 12-month KCCQ improvement of seven points versus controls. E-INH found no early reduction in death or hospitalization but demonstrated lower all-cause mortality at five and ten years (HR 0.82 and 0.83, respectively). The ACO registry showed a non-significant reduction in 6-month readmissions yet revealed markedly lower short-term mortality (6.4% vs 17%). Across studies, adherence to monitoring varied, with engagement declining over time, emphasizing the need for structured support strategies.

Conclusion: Collectively, evidence supports RPM as an effective adjunct to guideline-based HF management, improving quality of life, reducing hospitalizations, and potentially lowering long-term mortality when sustained adherence is achieved.