Implementation of a digital fatigue monitoring system for heart failure patients: a real-world feasibility study at a tertiary heart center

Abstract Background Fatigue is a key but underrecognized symptom of heart failure (HF), traditionally assessed subjectively. Biomarkers like NT-proBNP guide risk stratification, but digital health tools leveraging wearable data for early deterioration detection remain unexplored in routine HF management. Since January 2024, a National Heart Center, has implemented a digital fatigue monitoring system to evaluate the feasibility of integrating remote symptom tracking into HF management. Purpose To assess the feasibility, patient adherence, and predictive value of a wearable-integrated fatigue monitoring system for detecting early HF deterioration. Methods Prospective observational study (January 2024 – March 2025). 150 HF patients (NYHA II-III, LVEF 50%) enrolled at a National Heart Center. Intervention: Wearable devices (step count, heart rate variability HRV). Weekly digital fatigue questionnaire via mobile app (Fatigue Severity Scale FSS). Results Primary: Patient adherence (≥75% weekly symptom reporting). Correlation of fatigue scores with NT-proBNP trends. Association of step count 6) correlated with NT-proBNP elevation (R=0.69, p0.001). Declining step count variability & HRV predicted HF hospitalization (median 8-day lead time, p=0.01). 26% lower acute HF admission rates in digitally monitored patients vs. standard care (p=0.03). Conclusion Early findings suggest that a digital fatigue monitoring system is feasible, predictive of HF deterioration, and may reduce hospitalizations. If validated in larger studies, integrating wearable-derived metrics & patient-reported outcomes (PROs) into routine HF care could revolutionize HF monitoring and early intervention.