Telemonitoring in heart failure

Heart failure disease management programmes are now well established and their role in facilitating self care and improving outcome is recognised in international guidelines.1 Despite this, only 20% of patients in the UK are offered specialist follow-up on hospital discharge,2 and it is unclear how many patients actually enter such management programmes. Heart failure typically affects the elderly and very elderly, and their limited mobility and lack of social support may make hospital clinic attendance problematic. Home visits may bridge this gap, but are costly in terms of travel time for the health professional, thus limiting the case load that a specialist heart failure nurse can take on. Health care resources are therefore often unable to match the demands of recommended optimal care in heart failure. This problem is set to increase as the world population ages at an unprecedented rate. In response, policymakers have promoted the use of telehealth (“health care at a distance”), with the aim of widening access to high quality care and providing such care closer to home. As part of this broader concept of telehealth, telemonitoring has the potential to extend the reach of heart failure management programmes and provide care at a time and place more convenient to the patient. Remote monitoring using telephone support or patient initiated electronic monitoring has developed rapidly in the past 10 years, and can take many forms. There are key differences between the models: telephone support relies upon the patient’s interpretation of signs and symptoms and reporting of these during structured telephone contact, while patient initiated electronic monitoring (telemonitoring) transfers physiological data from the patient in their home to the health care provider. More recently, data from implanted devices, such as from a pacemaker or defibrillator, can also be monitored remotely, often without the need for …