Is telemonitoring a good idea for advanced heart failure?

Photo of a man measuring his blood pressure

The daily transmission of health data such as blood pressure, ECG values, and body weight to a medical center can have advantages for people with severe heart failure. This type of telemonitoring probably reduces the risk of dying from things like or sudden cardiac death.

People who have a very weak heart are often short of breath and have difficulty breathing even after slight exertion. This can restrict daily life or make your usual everyday activities impossible. Advanced heart failure can also cause heart rhythm problems and lung infections.

If you have advanced heart failure, it's important to have regular check-ups with your doctor, who can then adjust the treatment as needed.

Telemonitoring gaining popularity

The option of having your health status monitored from home is a relatively new development. It is known as “telemonitoring.” Various health parameters are measured at home and regularly sent to a telemedicine center by computer, tablet or smartphone. The aim is to spot abnormalities early and then be able to react right away – quicker than would be possible with regular doctor’s appointments. For instance, the data can be used to arrange examinations, adjust medication doses or call an ambulance in an emergency.

There are two main types of telemonitoring:

  • Self-measurement: Patients are given training in things like how to weigh themselves, measure their blood pressure, do an ECG or assess their general state of health, and then send their electronic health data to the telemedicine center. No special technical skills are needed.
  • Automated measurement and transfer: This is only possible for people with advanced heart failure who have an implanted device such as a defibrillator. When needed, defibrillators send electrical signals that return the heart’s rhythm. Some models are also suitable for fully-automated telemonitoring where the health data is forwarded to a telemedicine center without the patient having to do anything themselves.

In Germany, the costs for telemonitoring are covered for advanced heart failure if the heart failure has reached a certain level of severity and has been treated at a hospital. The telemonitoring also has to meet certain conditions.

Studies on telemonitoring

Researchers at the Institute for Quality and Efficiency in Health Care (IQWiG) assessed the pros and cons of intensive telemonitoring in advanced heart failure. They analyzed the results of four studies with a total of over 3,000 participants. Most of them were male, at least 65 years old, and they had impaired physical fitness. The studies lasted for one or two years.

One half of the participants were given conventional treatment by their doctor, and the other half were also monitored with telemonitoring. The studies compared the two groups. The collection of health data was fully automatic in two of the studies, and the participants measured it on their own in the other two.

What criteria were used for the studies and the telemonitoring?

Only studies that looked into intensive telemonitoring were included. A number of minimum requirements had to be met for the telemonitoring to classify as intensive:

  • At a minimum heart rate and rhythm were measured, general state of health was assessed, or physical activity was tracked during telemonitoring.
  • The health data was sent to a telemedicine center on a daily basis.
  • The health data was evaluated in the center by in-house specialists.
  • The center and the doctor’s office reacted quickly to abnormal health data, e.g. within 24 hours.

Intensive telemonitoring can have advantages

The analysis of the studies makes it possible to draw some preliminary conclusions: According to the studies, people with advanced heart failure who were monitored with intensive telemonitoring died less often of a cardiovascular disease.

One exception was if self-measurement was used for the intensive telemonitoring. The two studies that examined this more active type of telemonitoring over a period of one to two years suggest that telemonitoring increases chances of survival, but only for people without signs of depression.

  • Without telemonitoring, about 14 out of 100 people died.
  • With telemonitoring, about 10 out of 100 people died.

More recent evaluations of studies also found that telemonitoring can increase life expectancy. The use of telemonitoring can also mean that people with heart failure may have to go to the hospital less often because of their condition.

Unanswered questions

In these studies, telemonitoring had no overall effect on the typical symptoms of heart failure, on strokes, or on severe heart rhythm disorders. In participants with a defibrillator, there was also no difference in the number of electrical signals that the device had to send out to restore the heart rhythm.

It was not possible to evaluate the side effects of telemonitoring based on these studies. Some suitable data on the influence on state of health and quality of life was missing as well.

Alotaibi S, Hernandez-Montfort J, Ali OE et al. Remote monitoring of implantable cardiac devices in heart failure patients: a systematic review and meta-analysis of randomized controlled trials. Heart Fail Rev 2020; 25(3): 469-479.

Institute for Quality and Efficiency in Health Care (IQWiG, Germany). Data-supported timely management in cooperation with a centre for telemedicine for patients with advanced cardiac failure. Rapid report: Commission N19-01. 2019.

Kitsiou S, Vatani H, Pare G et al. Effectiveness of Mobile Health Technology Interventions for Patients With Heart Failure: Systematic Review and Meta-analysis. Can J Cardiol 2021; 37(8): 1248-1259.

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

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Created on November 15, 2023

Next planned update: 2026


Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

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