Electronic and telemedicine techniques to manage heart failure.

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.