Remote management of heart failure: Herculean or Sisyphean task?

Heart failure (HF) manifests as a severe functional limitation and myriad physiological derangements. Divining signals from this milieu is the domain of the HF specialist among whom there is an indelible belief that more effective HF care intrinsically arises from more communication, more measurement and, increasingly, more complex methods of acquiring and processing patient-generated data. Mobile technologies and electronically integrated systems of care eem to facillitate perfectly the steps of data generation, transmission, synthesis, interpretation, action and, ultimately, benefit to the patient. Unfortunately, realising improved outcomes among persons with HF enabled by outpatient monitoring has been elusive. In this issue of Heart , Rahimi et al 1 present results of a randomised trial designed to test whether centralised decision support optimised medical therapies and improved quality of life among patients compared with monitoring without centralised decision support. This hypothesis is of paramount importance. The authors’ study employs state-of-the-art blinding, randomisation, endpoint measurement and analysis to maximise the validity of their study. Nonetheless, the study ultimately could not conclude that expert support and alerts improved the primary outcome of medication use and dosing and quality of life compared with monitoring alone. The weighted change in medication optimisation demonstrated an improvement of 3% in the control group and 8% in the intervention group (p=0.20) …