Role of telephone monitoring in patients with chronic heart failure: theory and practical implications

With the aging of the world's population and the rise of chronic illness such as heart failure (HF), the economic burden, number of hospitalizations, and penalties imposed for failure to meet hospital readmission expectations will continue to rise, thus increasing pressure on clinicians to utilize successful HF monitoring interventions to improve these measures. Telephone monitoring in patients with chronic HF utilizes a proactive approach in the care of such patients, and for this review is grouped into three categories, ie, structured telephone support, telemonitoring, and remote implantable device monitoring. Earlier studies on structured telephone support and telemonitoring suggested a clear benefit on mortality and HF admissions, although several recent large, randomized controlled studies have been neutral. Optimizing medical therapy requires an accurate assessment of volume status by the clinician; therefore, symptom report and weight monitoring alone are often challenging in the identification of true HF decompensation because they are not very sensitive markers. The use of remote monitoring technology for follow-up of patients with implantable devices, including implantable cardiac defibrillators and cardiac resynchronization therapy devices, can aid in identifying HF decompensation. Self-care or self-management is an essential component of a chronic illness such as HF, and it is important for such patients to be engaged in their health care to best utilize the telephone monitoring intervention. System design, adequate staffing, patient satisfaction, and treatment adherence are important for success of the telemonitoring system. Telephone monitoring seems to be an effective approach in the chronic HF population. In the future, large-scale telemonitoring programs may come into place as well as additional remote implantable monitoring devices.