Remote Monitoring in Heart Failure: Strategies to Prevent Hospital Readmissions
Hospital readmission remains a critical concern for those who manage patients with heart failure (HF), with approximately 1 million admissions annually in the United States and mortality reaching 75% within 5 years of hospitalization.
In his presentation at American College of Physicians Internal Medicine Meeting 2025 in New Orleans, LA, Shudhanshu Alishetti, MD, advanced heart failure cardiologist at New York-Presbyterian Brooklyn Methodist Hospital and Weill Cornell Medicine, highlighted the benefits of remote monitoring strategies, physiologic tracking, and structured patient education to reduce hospitalization risk.
Heart failure is among the most prevalent causes of hospitalization in the United States, with 6.5 million patients affected and associated costs nearing $32 billion annually. “Heart failure has a very high burden in the US,” Dr Alishetti said in an interview with Consultant360. “The number of patients affected with heart failure keeps going up. By 2030, we expect there to be eight million people with heart failure.”
Despite the availability of guideline-directed medical therapy (GDMT) that offers substantial mortality risk reduction, Dr Alishetti noted that uptake remains limited. Indeed, fewer than 25% of patients receive all three recommended drug classes, and only 1% achieve target doses of ACE inhibitors/angiotensin receptor blockers, beta-blockers, and mineralocorticoid receptor antagonists. This treatment gap stems from the need for ongoing monitoring, laboratory testing, and follow-up.
Dr Alishetti’s presentation included a case-based discussions of two older men who experienced progressive functional decline. Their care journey demonstrated the value of individualized medication titration, adherence to daily weight monitoring, and the incorporation of advanced tools such as CardioMEMS for hemodynamic surveillance. Remote monitoring tools like CardioMEMS have shown promise in clinical trials and real-world settings, with substantial reductions in HF-related hospitalizations and improvements in patient-reported quality of life.
“When someone is first diagnosed with heart failure and they are admitted to the hospital, the average, about 50% of people, survive to 2 years,” Dr Alishetti explained in his interview with C360. “So that means half the people will be dead before 2 years. When you start adding on readmissions there, when you get to the fourth readmission, that changes to 50% mortality in 6 months. So it really is a marker of sick patients, and we really want to…use it as a surrogate to try to say, ‘Hey, if these readmissions make people sicker, if we can limit the amount of readmissions they have, can they be more stable and do better long term?’”
In addition to daily weights and strict dietary adherence, remote physiologic monitoring was introduced, which allowed for early intervention and stabilization. Technologies such as HeartLogic and ReDS (Remote Dielectric Sensing) were also reviewed, demonstrating emerging capabilities in fluid status assessment and early HF decompensation prediction.
Several randomized controlled trials were discussed, including TIM-HF2, which showed that treating five patients with a telemonitoring-based intervention for 1 year prevented 1 month of unplanned hospitalization. The MONITOR-HF trial confirmed CardioMEMS efficacy in improving Kansas City Cardiomyopathy Questionnaire scores and reducing HF hospitalization rates. However, earlier trials such as BEAT-HF and a study by Chaudhry and colleagues found no significant differences in readmission or mortality with telemonitoring compared to usual care, highlighting the need for nuanced implementation strategies.
Dr Alishetti ended his presentation by reviewing the dual nature of remote monitoring in heart failure care. He listed the benefits, which include improved patient engagement, especially among immobile individuals, greater health literacy, quicker GDMT titration, and reduced hospitalizations, supported by integration with EMRs and structured response protocols. However, challenges persist, such as reduced in-person follow-up, patient confusion from frequent medication changes, limited digital access, and barriers among elderly patients due to cognitive or sensory impairments.
Considering these persistent challenges—and the sobering outcomes associated with heart failure—Dr Alishetti emphasized to C360 the need to reframe how clinicians approach the condition.
“From the time of admission, mortality for heart failure is pretty high, with 50% of people surviving to 2 years,” Dr Alishetti said. “So it's kind of on the same level as stage three lung cancer. And of course, you know, we treat lung cancer very seriously… So I think we should look at heart failure the same way: that we should be treating these patients as aggressively as you treat people with malignancies.”
Reference
Alishetti S. Keeping patients with heart failure out of the hospital: get out and stay out. Talk presented at: American College of Physicians - Internal Medicine Meeting 2025; April 3-5, 2025; New Orleans, LA. Accessed March 27, 2025. https://annualmeeting.acponline.org/educational-program/scientific-program/scientific-sessions.