Remote monitoring, used in tandem with a system of care geared toward engaging, informing and empowering patients, is needed to provide heart failure (HF) management at home that effectively controls symptoms, avoids hospitalization and improves the patient’s perception of their illness, according to a JACC Scientific Statement published June 5.

In the statement, Lynne Warner Stevenson, MD, FACC, et al., review lessons learned from early telemonitoring of weights and symptoms, writing that results from these initial trials helped determine what is required for remote monitoring to effectively reduce HF hospitalizations. These vital components include: “dynamic signals that reflect the physiology of decompensation; algorithms that define signal thresholds and link them to therapeutic intervention; and intersecting circles of multidisciplinary team to connect to patients and respond to remote monitoring data.”

The authors highlight that effective remote monitoring for high-risk patients requires a signal that is “accurate and actionable with response kinetics for early reassessment.” They identify relief and prevention of congestion as a major target for decreasing HF hospitalizations and improving patient quality of life, in which monitoring cardiac filling pressures or lung water content has shown most benefit to date.

Signal specifications differ for monitoring patients deemed low risk, where multiparameter scores from implanted rhythm devices have helped pinpoint trends that may warrant further clinical evaluation. The authors call for improvement of current algorithms with more precise personalization of signal thresholds and intervention.

In addition, they evaluate challenges still present in the digital health care space, namely the digital divide and gaps in access to HF care teams.

“The development of digital health care technologies will not replace the multidisciplinary teams vital to equitable access in the expanding HF populations,” state the authors. “If we can elevate priority for universal access to [HF management] care teams and remote management, we can share in deep learning about the physiological patterns of ambulatory HF…”

Clinical Topics: Heart Failure and Cardiomyopathies, Acute Heart Failure

Keywords: Power, Psychological, Patient Care Team, Algorithms, Hospitalization, Heart Failure, Quality of Life

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