Remote monitoring in heart failure: it’s the data you collect and what you do with them

The numerous studies using data derived from cardiac implantable electronic devices or external devices have provided inconsistent results, even in higher risk individuals.1 The term ‘acute’ decompensated heart failure implies a process occurring rapidly, but in heart failure this is seldom the case, with the majority of admissions following gradual haemodynamic and symptomatic deterioration.2 Therefore, lack of time to intervene and prevent a decompensation is unlikely to be a significant barrier for remote monitoring strategies. [...]the two aspects of the care pathway—the signal and our response to it—are inseparable, and both must be aligned to avoid neutral outcomes with increased costs. [...]the lessons of the past have taught us that new technology can lead us astray, giving us a false sense of knowledge and increased activity with no overall benefit.7 Early health economic analyses based on CHAMPION8 (CardioMEMS HF Sensor Allows Monitoring of Pressures to Improve Outcomes in NYHA Functional Class III Heart Failure Patients) were broadly favourable using European and US criteria, but more work is required from populations receiving contemporary heart failure therapies before we can conclude these devices are truly cost-effective. Given the poor rates of guideline-directed medical therapy optimisation in contemporary practice, it serves to contrast the largely neutral results of the remote monitoring studies with those of the recent STRONG-HF (Safety, Tolerability and Efficacy of Rapid Optmization, Helped by NT-proBNP Testing, of Heart Failure Therapies) trial,9 where marked reductions in all-cause hospitalisations and improved quality of life were achieved by an intensive, multidisciplinary follow-up programme.