Challenges to telemedicine in heart failure management in armed conflict settings

Background Heart failure (HF) management in conflict zones presents unique logistical and clinical challenges. In regions affected by recent armed conflict, access to healthcare has been severely disrupted. While telemedicine offers potential to sustain continuity of care, its feasibility in such fragile settings remains underexplored. Purpose To assess patients’ knowledge, accessibility, and challenges in using telemedicine for HF management during an ongoing armed conflict, and to evaluate its impact on continuity of care. Methods A cross-sectional study was conducted between August 2024 and May 2025 among 190 outpatients with HF recruited from five hospitals across five regions in a country with an ongoing armed conflict. Structured, interviewer-administered questionnaires were used to assess telemedicine awareness, access barriers, and healthcare continuity. Data were analyzed using descriptive and inferential statistics with Statistical Package for the Social Science software. Results Most patients (92.1%) were on HF medications; however, 7.9% reported access challenges, primarily due to unaffordability (4.7%) and unavailability (1.6%). Telemedicine use was minimal (5.8%), and awareness was poor, with 87.2% of respondents unaware of any available telemedicine services. Major barriers included lack of internet access (21.3%), unstable electricity (13.8%), and absence of digital devices (12.2%). Conflict conditions further impeded care—28.4% of patients were internally displaced, and 21.1% reported safety concerns. Only 42.1% had recent clinical follow-up, while 14.7% had not received care for over a year. Nearly one-third (31.2%) experienced severe HF symptoms, and none were aware of their specific HF subtype. Telemedicine knowledge strongly predicted use (p < 0.001), while displacement was associated with care disruption (p = 0.032). Conclusion Telemedicine adoption for HF management in conflict-affected settings remains extremely limited, constrained by poor digital infrastructure, low awareness, and population displacement. Investment in low-bandwidth, resilient telehealth platforms and targeted education for patients and providers is urgently needed to preserve continuity of care.