Structuring telemonitoring in heart failure care in The Netherlands: design and operational protocol of a nationwide initiative

Aims Home telemonitoring systems (hTMS) have demonstrated positive effects on hospitalizations and mortality for patients with heart failure (HF). However, there is a high degree of heterogeneity in the development and integration of hTMS. This limits the potential for large-scale impact and equitable access to high-quality remote care. Therefore, this manuscript describes a detailed protocol of a scalable high-volume hTMS system which has been standardized and implemented across seven large teaching hospitals in The Netherlands (Graphical Abstract). Methods A multicentre, qualitative, stakeholder-inclusive approach was applied from the early stages of the hTMS protocol development. In January 2023, a HF-core team was established, comprising cardiologists, HF nurse specialists, and experts in implementation and process optimization, from all hospitals. The team developed unified protocols for remote monitoring of vital signs (blood pressure, heart rate, weight), including standardized cut-off values to generate automated alerts. In addition, protocols were established on how to rapidly titrate HF medication with the use of hTMS. A new department, the Medical Service Centre was established in each site to monitor these alerts and contact patients. Conclusion This manuscript describes the development of the hybrid care pathway and the operational protocol of the hTMS. Future publications will elaborate on outcomes related to implementation success, clinical endpoints, and cost-effectiveness, which are currently being collected and evaluated as part of the programmes prospective design.