by Lindsey Cotten, MSN, CCDS, FNP-BC

When I first started in the world of cardiac devices in 2013, heart failure remote monitoring was fairly new and still poorly understood. The clinic I was part of was large and very busy, and we were not eager to add HF remote monitoring to our already very full workload. In 2019, I started my first nurse practitioner job and was asked to start a heart failure remote monitoring program for a smaller clinic that served about 2000 patients. By this time, there was solid evidence that HF remote monitoring improves outcomes, so I wasn’t surprised that the clinic needed to start providing this service. I was, however, more than a little overwhelmed and didn’t know where to start. There were challenges at the beginning, but I found that it was not an impossible task. Since then, I’ve been part of teams across the country that have successfully added HF remote monitoring to the services they provide their patients. Here are a few things to consider before embarking on this journey.

Assess staffing needs.

Managing heart failure data effectively requires tasks such as scheduling remote transmissions, analyzing data, contacting patients for symptom assessment, and processing charges. The extent of the impact on staff workload can vary depending on the number of patients enrolled in the service. In my experience at my clinic in Birmingham, we successfully delegated certain administrative duties to a different department. This strategy enabled us to launch our HF remote monitoring program without needing additional staff. While strategic planning and creative delegation can be effective, this is often not possible. Outsourcing your service need can be a financially viable option.

Create a good protocol.

In my experience, the most effective HF remote monitoring protocols are intuitive, address the most commonly encountered issues, clearly specify which staff members are responsible for which tasks, and are user-friendly. Collaboration with heart failure colleagues can be very beneficial in the drafting phase. Considerations for your clinic’s protocol should include managing out-of-range HF diagnostics, timing for follow-ups post- medication adjustments, criteria for in-office patient visits, and determining the appropriate provider for each scenario.

Educate your patients.

From a nursing standpoint, patient education is paramount. Patients who fully grasp the importance and functionality of HF remote monitoring are typically more adherent and proactive in their health management. During my clinical practice, I prioritized direct, in-person discussions about HF remote monitoring during clinic visits before enrolling patients. For patients with new devices, this was easily incorporated into the post-op visit. Just as with any new device implant, patients need to understand that the device is not infallible and that clinical correlation is key. For existing patients, letters or EMR messages can be a simple and effective way of informing them about the service while also offering an invitation to reach out with questions or concerns if initiated between office visits.

Driven by the love for patients that first drove me to become a nurse, I was determined to overcome obstacles and start a successful HF remote monitoring for my patients. It could have been a daunting task, but identifying needs, formulating a good plan, and recruiting support contributed to the success of this initiative. If you find yourself in a similar position, CV Remote Solutions is here to bridge the gap by offering tailored programs that align with both clinician workflows and patient needs while maintaining the financial viability of the practice. We are committed to help equip your team with the tools and knowledge necessary for a successful heart failure monitoring program and want to see your patients thrive.