The “eye in the sky”: remote sensing technologies in heart failure-from physiologic monitoring to predictive care

Heart failure remains a leading cause of hospitalization, readmission, and health care utilization worldwide. Although advances in pharmacologic and device-based therapies have improved outcomes, clinical management continues to rely largely on episodic assessments that often identify decompensation only after symptoms emerge. This reactive paradigm limits opportunities for early intervention and contributes to persistently high hospitalization rates. Recent advances in wearable and remote sensing technologies have enabled continuous, ambulatory assessment of cardiovascular physiology. Implantable, subcutaneous, and wearable sensors now provide longitudinal data on hemodynamics, impedance, heart rhythm, respiratory patterns, physical activity, and functional status. Emerging evidence demonstrates that these technologies can detect physiologic deterioration days to weeks before overt clinical worsening, creating the potential to shift heart failure care from symptom-driven response to anticipatory management. This review synthesizes current evidence supporting remote sensing technologies in heart failure, emphasizing physiologic relevance, predictive capability, and clinical actionability.