Telemedicine in heart failure care: a qualitative study

Abstract Background Telemedicine is increasingly adopted in heart failure (HF) care to enhance continuity, support daily symptom monitoring, and strengthen patient education and self-care. However, despite extensive reporting of clinical outcomes, patients’ lived experiences of telemedicine and the factors shaping engagement and acceptability remain insufficiently explored. Purpose To explore and interpret the experiences and perceptions of patients with HF participating in a home-based telemedicine programme, and to identify factors influencing engagement and acceptability. Methods We conducted an inductive qualitative content analysis in patients with chronic HF enrolled in a structured telemedicine programme delivered by a specialist cardiology service. Semi-structured, face-to-face interviews were audio-recorded and transcribed verbatim. Transcripts were anonymised, coded line-by-line, and analysed inductively to derive subcategories and overarching categories through iterative discussion among researchers. Data collection continued until thematic saturation was reached. The study conduct and reporting were guided by the Consolidated Criteria for Reporting Qualitative Research (COREQ). Results Data saturation was achieved after 21 interviews. The analysis generated five main categories and 13 subcategories. (1) Perceived benefits of telemedicine included enhanced reassurance and a sense of clinical safety, improved awareness of symptoms and behaviours, increased perceived control, and a willingness to recommend the programme to other patients. (2) Impact on everyday life encompassed both convenience and burden: monitoring was sometimes time-consuming, could be difficult to integrate into daily routines, and occasionally triggered uncertainty or emotional strain. (3) Relationships with healthcare professionals emerged as a central driver of acceptability, with participants describing perceived "presence" and support, trust in professional competence, and a desire for more frequent or proactive feedback based on transmitted data. (4) Technology and usability barriers included device-related problems, inconsistent connectivity, and frustration when measurements failed or required repetition. (5) Family and social context influenced engagement through practical help and emotional support, but also through mixed reactions from relatives, ranging from reassurance to feelings of being controlled or monitored. Conclusions Telemedicine can enhance perceived safety, self-management, continuity of care, and treatment adherence in HF, particularly when supported by strong patient–clinician relationships, reliable technology, and alignment with daily routines and family dynamics. To optimise acceptability, future programmes should be co-designed with patients and caregivers, ensure two-way communication, clarify how monitoring data are used, and adopt flexible, personalised strategies that minimise burden.