Opinion statement
Electronic monitoring and telemedicine techniques are effective tools to manage patients with moderate and high risk heart failure as part of a multidisciplinary disease management system. They have been shown to reduce hospitalization and emergency room visits, improve quality of life, and possibly impact mortality. In addition, several have been shown to be cost-effective. They encourage patient education and self-management and facilitate guideline-mandated care. These technologies can improve efficiency by allowing a single clinician to closely manage many patients in a high-quality manner. Simultaneously, these systems can burden the existing health care system by adding large volumes of new data that need to be reviewed and acted upon. Payers must develop realistic reimbursement schemes to offset the costs of supervising these systems. Newer devices that collect many physiologic variables, including some that invasively record ambulatory hemodynamics, add significant complexity, but it is unclear whether this additional data will improve management and outcomes to justify the incremental risks and costs.
Similar content being viewed by others
References and Recommended Reading
American Heart Association: Heart Disease and Stroke Statistics - 2005 Update. Dallas, TX: American Heart Association; 2005.
Hunt SA, Baker DW, Chin MH, et al.: ACC/AHA Guidelines for the Evaluation and Management of Chronic Heart Failure in the Adult: Executive Summary A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1995 Guidelines for the Evaluation and Management of Heart Failure): Developed in Collaboration With the International Society for Heart and Lung Transplantation; Endorsed by the Heart Failure Society of America. Circulation 2001, 104:2996–3007.
Benatar D, Bondmass M, Ghitelman J, Avitall B: Outcomes of chronic heart failure. Arch Intern Med 2003, 163:347–352. Compared home care nursing versus nurse telemanagement using noninvasive physiologic monitors that demonstrated that the telemedicine patients had fewer admissions with decreased health care costs. Suggests a “value added” to the telemedicine intervention compared with traditional home care.
Mueller TM, Vuckovic KM, Knox DA, Williams RE: Telemanagement of heart failure: a diuretic treatment algorithm for advanced practice nurses. Heart Lung 2002, 31:340–347.
Field MJ, Grigsby J: Telemedicine and remote patient monitoring. JAMA 2002, 288:423–425.
Moyer-Knox D, Mueller TM, Vuckovic K, et al.: Remote titration of carvedilol for heart failure patients by advanced practice nurses. J Card Fail 2004, 10:219–224.
Riegel B, Carlson B, Glaser D, Hoagland P: Which patients with heart failure respond best to multidisciplinary disease management? J Card Fail 2000, 6:290–299. Evaluated subgroups of patients with heart failure and deterined that those with moderate heart failure received the most benefit from disease management interventions.
Goldberg LR, Piette JD, Walsh MN, et al.: 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 2003, 146:705–712. A large, multicentered, randomized clinical trial assessing the use of an electronic scale system versus usual care that demonstrated an improved survival for those receiving the intervention.
Rich MW: Heart failure disease management programs: efficacy and limitations. Am J Med 2001, 110:410–412. An editorial that discusses many of the issues that limit the implementation of disease management and explains the need for additional studies to define the role of these programs.
Schneider NM: Managing congestive heart failure using home telehealth. Home Healthcare Nurse 2004, 22:719–722.
Duffy JR, Hoskins LM, Chen MC: Nonpharmacological strategies for improving heart failure outcomes in the community: a systematic review. J Nurs Care Qual 2004, 19:349–360.
Riegel B, Carlson B, Kopp Z, et al.: Effect of a standardized nurse case-management telephone intervention on resource use in patients with chronic heart failure. Arch Intern Med 2002, 162:705–712.
Canesin MF, Giorgi D, Oliveira MT, et al.: Ambulatory blood pressure monitoring of patients with heart failure. A new prognosis marker. Arg Bras Cardiol 2002, 78:83–89.
Artinian NT, Harden JK, Kronenberg MW, et al.: Pilot study of a Web-based compliance monitoring device for patients with congestive heart failure. Heart Lung 2003, 32:226–233.
Jerant AF, Azari R, Martinez C, Nesbitt TS: A randomized trial of telenursing to reduce hospitalization for heart failure: patient-centered outcomes and nursing indicators. Home Health Care Sew Q 2003, 22:1–220.
Cordisco ME, Benjaminovitz A, Hammond K, Mancini D: Use of telemonitoring to decrease the rate of hospitalization in patients with severe congestive heart failure. Am J Cardiol 1999, 84:860–862.
Roth A, Kajiloti I, Elkayam I, et al.: Telecardiology for patients with chronic heart failure: the ‘SHL’ experience in Israel. Int J Cardiol 2004, 97:49–55.
Kjellstrom B, Linde C, Bennett T, et al.: Six years follow-up of an implanted SvO(2) sensor in the right ventricle. Eur J Heart Fail 2004, 6:627–634.
Ohlsson A, Steinhaus D, Kjellstrom B, et al.: Central hemodynamic responses during serial exercise tests in heart failure patients using implantable hemodynamic monitors. Eur J Heart Fail 2003, 5:253–259.
Adamson PB, Magalski A, Braunschweig F, et al.: Ongoing right ventricular hemodynamics in heart failure: clinical value of measurements derived from an implantable monitoring system. J Am Coll Cardiol 2003, 41:565–571.
Magalski A, Adamson P, Gadler F, et al.: L Continuous ambulatory right heart pressure measurements with an implantable hemodynamic monitor: a multicenter, 12-month follow-up study of patients with chronic heart failure. J Card Fail 2002, 8:63–70.
Ohlsson A, Kubo SH, Steinhaus D, et al.: Continuous ambulatory monitoring of absolute right ventricular pressure and mixed venous oxygen saturation in patients with heart failure using an implantable haemodynamic monitor: results of a 1 year multicentre feasibility study. Eur Heart J 2001, 22:942–954.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Goldberg, L.R. Electronic and telemedicine techniques to manage heart failure. Curr Treat Options Cardio Med 7, 333–338 (2005). https://doi.org/10.1007/s11936-005-0044-9
Issue Date:
DOI: https://doi.org/10.1007/s11936-005-0044-9