Telemonitoring and Contemporary Outpatient Management of Patients with Heart Failure: Is it Time?
Tamas Alexy, Gary S. Francis
Department of Medicine, Division of Cardiology, University of Minnesota, Minneapolis, MN 55455, USA
Chronic heart failure is not going away, but continues to expand globally. This is largely driven by new cases of heart failure with preserved ejection fraction. Patients receive chronic disease management complicated by frequent hospitalizations to treat episodes of exacerbation that not only affect quality of life but is also associated with a significant financial burden to the society. With a better understanding of heart failure pathophysiology, our management strategy has shifted progressively from reactive to preventive, such as daily weight monitoring and interaction with specialized nurses. With the advent of new technology, non-invasive remote monitoring is now more available with regular, automatic data transmission to the health care center, including heart rate, blood pressure, weight and daily activity. The widespread use of implanted cardioverter defibrillators and cardiac resynchronization therapy in patients with heart failure has enabled the expansion of these devices with various indwelling sensors aimed at monitoring volume status and predicting need for hospitalization. As the success of this approach was noted to be limited, implantable hemodynamic sensors have been subsequently developed in an attempt to reduce heart failure hospitalizations and mortality. This manuscript provides a brief review and clinical utility of the available remote monitoring approaches and devices for patients with heart failure.