Home is Where the Heart is....Or is it?

Heart failure is a chronic disease process that predominantly affects an elderly population with multiple comorbidities, and despite improved therapies, it inexorably advances to late stages in many people.All of this, it would seem, would make heart failure and home care and home monitoring a natural fit.If this is coupled with tremendous advances in communication technology and bandwidth, one might say that the concept of telemonitoring a patient with heart failure is a "no-brainer."Therefore, several months ago, led by an intriguing paper on the validation of a home telemanagement system, we issued a call for papers on the topic of telemanagement.Many phone calls came in and all our inquiries to the usual suspects were met with great enthusiasm.Yet, in the end, relatively few manuscripts arrived.Presented in this issue are three intriguing and terrific manuscripts; read them and enjoy.I question, however, why more data are not available for this forum of over 20,000 readers, all of whom have an announced interest in heart failure management.My take on all this is twofold.First of all, despite the emergence of increasing numbers of home monitoring companies, their utilization remains, for now, firmly rooted within managed care.Sure, everyone uses some telemanagement schemes, but few heart failure experts I talk to are using a predominant home or telemanagement strategy for the majority of their patients.The reasons abound, including lack of sophistication of the end-users, lack of a good general product, and so on.If the truth be known, I feel the initial cost and lack of a reimbursement mechanism inhibits a broader application of these services.Thus, until we find new and more cost effective ways to diagnose and treat heart failure and provide chronic care, broad incorporation of home based telemanagement, despite demonstrated efficiency, is unlikely to occur.Finally (and I am guilty here as well), there is the issue of quality control.This refers to the fact that the home based, telemonitored program is not a robotic set of computer commands or even automated steps in an algorithm; it is, for the most part, intermediaries stepping up to the role of a heart failure expert, and frankly, some do it well while others do it not so well.Similar to heart failure care in general, there remains too much variability; therefore, one is never Editorial Home is Where the Heart is....Or is it?