Heart Failure Reviews

, Volume 20, Issue 1, pp 107–116 | Cite as

Telemonitoring in heart failure: Big Brother watching over you

  • R. DierckxEmail author
  • P. Pellicori
  • J. G. F. Cleland
  • A. L. Clark


Heart failure (HF) is a leading cause of hospitalisations in older people. Several strategies, supported by novel technologies, are now available to monitor patients’ health from a distance. Although studies have suggested that remote monitoring may reduce HF hospitalisations and mortality, the study of different patient populations, the use of different monitoring technologies and the use of different endpoints limit the generalisability of the results of the clinical trials reported, so far. In this review, we discuss the existing home monitoring modalities, relevant trials and focus on future directions for telemonitoring.


Telemonitoring Heart failure Review Structured telephone support Implantable haemodynamic monitoring devices 



Prof. Cleland is supported, in part, by the NIHR cardiovascular Biomedical Research Unit at the Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London.

Conflict of interest

Departmental research support has been received from Philips.


  1. 1.
    Stewart S et al (2001) More ‘malignant’ than cancer? Five-year survival following a first admission for heart failure. Eur J Heart Fail 3(3):315–322PubMedCrossRefGoogle Scholar
  2. 2.
    McMurray JJ et al (2012) ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail 14(8):803–869PubMedCrossRefGoogle Scholar
  3. 3.
    Cleland JG et al (2003) The EuroHeart Failure survey programme—a survey on the quality of care among patients with heart failure in Europe. Part 1: patient characteristics and diagnosis. Eur Heart J 24(5):442–463PubMedCrossRefGoogle Scholar
  4. 4.
    Stewart S et al (2003) Heart failure and the aging population: an increasing burden in the 21st century? Heart 89(1):49–53PubMedCentralPubMedCrossRefGoogle Scholar
  5. 5.
    Heidenreich PA et al (2013) Forecasting the impact of heart failure in the United States: a policy statement from the American Heart Association. Circ Heart Fail 6(3):606–619PubMedCentralPubMedCrossRefGoogle Scholar
  6. 6.
    Stewart S et al (2002) The current cost of heart failure to the National Health Service in the UK. Eur J Heart Fail 4(3):361–371PubMedCrossRefGoogle Scholar
  7. 7.
    Lindenfeld J et al (2010) HFSA 2010 comprehensive heart failure practice guideline. J Card Fail 16(6):e1–e194PubMedCrossRefGoogle Scholar
  8. 8.
    Goldberg LR et al (2003) Randomized trial of a daily electronic home monitoring system in patients with advanced heart failure: the Weight Monitoring in Heart Failure (WHARF) trial. Am Heart J 146(4):705–712PubMedCrossRefGoogle Scholar
  9. 9.
    Landolina M et al (2012) Remote monitoring reduces healthcare use and improves quality of care in heart failure patients with implantable defibrillators: the evolution of management strategies of heart failure patients with implantable defibrillators (EVOLVO) study. Circulation 125(24):2985–2992PubMedCrossRefGoogle Scholar
  10. 10.
    Inglis SC et al (2011) Which components of heart failure programmes are effective? A systematic review and meta-analysis of the outcomes of structured telephone support or telemonitoring as the primary component of chronic heart failure management in 8323 patients: abridged Cochrane Review. Eur J Heart Fail 13(9):1028–1040PubMedCrossRefGoogle Scholar
  11. 11.
    Cleland JG et al (2005) Noninvasive home telemonitoring for patients with heart failure at high risk of recurrent admission and death: the Trans-European Network-Home-Care Management System (TEN-HMS) study. J Am Coll Cardiol 45(10):1654–1664PubMedCrossRefGoogle Scholar
  12. 12.
    Steventon A et al (2012) Effect of telehealth on use of secondary care and mortality: findings from the Whole System Demonstrator cluster randomised trial. BMJ 344:e3874PubMedCentralPubMedCrossRefGoogle Scholar
  13. 13.
    Abraham WT et al (2011) Wireless pulmonary artery haemodynamic monitoring in chronic heart failure: a randomised controlled trial. Lancet 377(9766):658–666PubMedCrossRefGoogle Scholar
  14. 14.
    Dendale P et al (2012) Effect of a telemonitoring-facilitated collaboration between general practitioner and heart failure clinic on mortality and rehospitalization rates in severe heart failure: the TEMA-HF 1 (TElemonitoring in the MAnagement of Heart Failure) study. Eur J Heart Fail 14(3):333–340PubMedCrossRefGoogle Scholar
  15. 15.
    Weintraub A et al (2010) A multicenter randomized controlled evaluation of automated home monitoring and telephonic disease management in patients recently hospitalized for congestive heart failure: the SPAN-CHF II trial. J Card Fail 16(4):285–292PubMedCrossRefGoogle Scholar
  16. 16.
    GESICA investigators (2005) Randomised trial of telephone intervention in chronic heart failure: DIAL trial. BMJ 331(7514):425Google Scholar
  17. 17.
    Ferrante D et al (2010) Long-term results after a telephone intervention in chronic heart failure: DIAL (Randomized Trial of Phone Intervention in Chronic Heart Failure) follow-up. J Am Coll Cardiol 56(5):372–378PubMedCrossRefGoogle Scholar
  18. 18.
    Chaudhry SI et al (2010) Telemonitoring in patients with heart failure. N Engl J Med 363(24):2301–2309PubMedCentralPubMedCrossRefGoogle Scholar
  19. 19.
    Steventon A et al (2013) Effect of telephone health coaching (Birmingham OwnHealth) on hospital use and associated costs: cohort study with matched controls. BMJ 347:f4585PubMedCentralPubMedCrossRefGoogle Scholar
  20. 20.
    Dar O et al (2009) A randomized trial of home telemonitoring in a typical elderly heart failure population in North West London: results of the Home-HF study. Eur J Heart Fail 11(3):319–325PubMedCentralPubMedCrossRefGoogle Scholar
  21. 21.
    Scherr D et al (2009) Effect of home-based telemonitoring using mobile phone technology on the outcome of heart failure patients after an episode of acute decompensation: randomized controlled trial. J Med Internet Res 11(3):34CrossRefGoogle Scholar
  22. 22.
    Domingo M et al (2011) Noninvasive remote telemonitoring for ambulatory patients with heart failure: effect on number of hospitalizations, days in hospital, and quality of life. CARME (CAtalan Remote Management Evaluation) study]. Rev Esp Cardiol 64(4):277–285PubMedCrossRefGoogle Scholar
  23. 23.
    Casas JP, Kwong J, Ebrahim S (2011), Telemonitoring for chronic heart failure: not ready for prime time. Cochrane Database Syst Rev. doi: 10.1002/14651858.ED000008
  24. 24.
    Koehler F et al (2011) Impact of remote telemedical management on mortality and hospitalizations in ambulatory patients with chronic heart failure: the telemedical interventional monitoring in heart failure study. Circulation 123(17):1873–1880PubMedCrossRefGoogle Scholar
  25. 25.
    Adams KF Jr et al (2005) Characteristics and outcomes of patients hospitalized for heart failure in the United States: rationale, design, and preliminary observations from the first 100, 000 cases in the Acute Decompensated Heart Failure National Registry (ADHERE). Am Heart J 149(2):209–216PubMedCrossRefGoogle Scholar
  26. 26.
    Stevenson LW (2006) Are hemodynamic goals viable in tailoring heart failure therapy? Hemodynamic goals are relevant. Circulation 113(7):1020–1027; discussion 1033Google Scholar
  27. 27.
    Zile MR et al (2008) Transition from chronic compensated to acute decompensated heart failure: pathophysiological insights obtained from continuous monitoring of intracardiac pressures. Circulation 118(14):1433–1441PubMedCrossRefGoogle Scholar
  28. 28.
    Abraham WT et al (2011) Intrathoracic impedance vs daily weight monitoring for predicting worsening heart failure events: results of the Fluid Accumulation Status Trial (FAST). Congest Heart Fail 17(2):51–55PubMedCrossRefGoogle Scholar
  29. 29.
    Zhang J et al (2009) Predicting hospitalization due to worsening heart failure using daily weight measurement: analysis of the Trans-European Network-Home-Care Management System (TEN-HMS) study. Eur J Heart Fail 11(4):420–427PubMedCrossRefGoogle Scholar
  30. 30.
    Bourge RC et al (2008) Randomized controlled trial of an implantable continuous hemodynamic monitor in patients with advanced heart failure: the COMPASS-HF study. J Am Coll Cardiol 51(11):1073–1079PubMedCrossRefGoogle Scholar
  31. 31.
    Zile MR et al (2008) Application of implantable hemodynamic monitoring in the management of patients with diastolic heart failure: a subgroup analysis of the COMPASS-HF trial. J Card Fail 14(10):816–823PubMedCrossRefGoogle Scholar
  32. 32.
    Steinhaus D et al (2005) Implant experience with an implantable hemodynamic monitor for the management of symptomatic heart failure. Pacing Clin Electrophysiol 28(8):747–753PubMedCrossRefGoogle Scholar
  33. 33.
    Cohen D, Billingsley M (2011) Europeans are left to their own devices. BMJ 342:d2748PubMedCrossRefGoogle Scholar
  34. 34.
    Loh JP, Barbash IM, Waksman R (2013) Overview of the 2011 Food and Drug Administration Circulatory System Devices Panel of the Medical Devices Advisory Committee Meeting on the CardioMEMS Champion Heart Failure Monitoring System. J Am Coll Cardiol 61(15):1571–1576PubMedCrossRefGoogle Scholar
  35. 35.
    O’’iordan M (2013) CardioMEMS HF implant narrowly passes FDA advisory hurdle.
  36. 36.
    Ritzema J et al (2010) Physician-directed patient self-management of left atrial pressure in advanced chronic heart failure. Circulation 121(9):1086–1095PubMedCrossRefGoogle Scholar
  37. 37.
    Adamson PB et al (2004) Continuous autonomic assessment in patients with symptomatic heart failure: prognostic value of heart rate variability measured by an implanted cardiac resynchronization device. Circulation 110(16):2389–2394PubMedCrossRefGoogle Scholar
  38. 38.
    Sarkar S et al (2012) Burden of atrial fibrillation and poor rate control detected by continuous monitoring and the risk for heart failure hospitalization. Am Heart J 164(4):616–624PubMedCrossRefGoogle Scholar
  39. 39.
    Braunschweig F et al (2005) Monitoring of physical activity and heart rate variability in patients with chronic heart failure using cardiac resynchronization devices. Am J Cardiol 95(9):1104–1107PubMedCrossRefGoogle Scholar
  40. 40.
    Yu CM et al (2005) Intrathoracic impedance monitoring in patients with heart failure: correlation with fluid status and feasibility of early warning preceding hospitalization. Circulation 112(6):841–848PubMedCrossRefGoogle Scholar
  41. 41.
    Vollmann D et al (2007) Clinical utility of intrathoracic impedance monitoring to alert patients with an implanted device of deteriorating chronic heart failure. Eur Heart J 28(15):1835–1840PubMedCrossRefGoogle Scholar
  42. 42.
    Conraads VM et al (2011) Sensitivity and positive predictive value of implantable intrathoracic impedance monitoring as a predictor of heart failure hospitalizations: the SENSE-HF trial. Eur Heart J 32(18):2266–2273PubMedCrossRefGoogle Scholar
  43. 43.
    Cleland JG, Antony R (2011) It makes SENSE to take a safer road. Eur Heart J 32(18):2225–2227PubMedCrossRefGoogle Scholar
  44. 44.
    van Veldhuisen DJ et al (2011) Intrathoracic impedance monitoring, audible patient alerts, and outcome in patients with heart failure. Circulation 124(16):1719–1726PubMedCrossRefGoogle Scholar
  45. 45.
    Brachmann J et al (2011) Fluid status monitoring with a wireless network to reduce cardiovascular-related hospitalizations and mortality in heart failure: rationale and design of the OptiLink HF Study (Optimization of Heart Failure Management using OptiVol Fluid Status Monitoring and CareLink). Eur J Heart Fail 13(7):796–804PubMedCentralPubMedCrossRefGoogle Scholar
  46. 46.
    Whellan DJ et al (2010) Combined heart failure device diagnostics identify patients at higher risk of subsequent heart failure hospitalizations: results from PARTNERS HF (Program to Access and Review Trending Information and Evaluate Correlation to Symptoms in Patients With Heart Failure) study. J Am Coll Cardiol 55(17):1803–1810PubMedCrossRefGoogle Scholar
  47. 47.
    Cowie MR et al (2013) Development and validation of an integrated diagnostic algorithm derived from parameters monitored in implantable devices for identifying patients at risk for heart failure hospitalization in an ambulatory setting. Eur Heart J 34(31):2472–2480PubMedCentralPubMedCrossRefGoogle Scholar
  48. 48.
    Thokala P et al (2013) Telemonitoring after discharge from hospital with heart failure: cost-effectiveness modelling of alternative service designs. BMJ Open 3(9):e003250PubMedCentralPubMedCrossRefGoogle Scholar
  49. 49.
    Henderson C et al (2013) Cost effectiveness of telehealth for patients with long term conditions (Whole Systems Demonstrator telehealth questionnaire study): nested economic evaluation in a pragmatic, cluster randomised controlled trial. BMJ 346:f1035PubMedCrossRefGoogle Scholar
  50. 50.
    Pandor A et al (2013) Remote monitoring after recent hospital discharge in patients with heart failure: a systematic review and network meta-analysis. Heart 99(23):1717–1726PubMedCrossRefGoogle Scholar
  51. 51.
    Maisel A et al (2013) Primary results of the HABIT Trial (heart failure assessment with BNP in the home). J Am Coll Cardiol 61(16):1726–1735PubMedCrossRefGoogle Scholar
  52. 52.
    Cleland JG, Ekman I (2010) Enlisting the help of the largest health care workforce–patients. JAMA 304(12):1383–1384PubMedCrossRefGoogle Scholar
  53. 53.
    Pandor A et al (2013) Home telemonitoring or structured telephone support programmes after recent discharge in patients with heart failure: systematic review and economic evaluation. Health Technol Assess 17(32):1–207, v–viGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • R. Dierckx
    • 1
    Email author
  • P. Pellicori
    • 1
  • J. G. F. Cleland
    • 2
  • A. L. Clark
    • 1
  1. 1.Department of Cardiology, Hull York Medical School, Hull and East Yorkshire Medical Research and Teaching CentreCastle Hill HospitalCottingham, Kingston upon HullUK
  2. 2.National Heart and Lung Institute, Royal Brompton and Harefield HospitalsImperial CollegeLondonUK

Personalised recommendations