There are already several ways to monitor certain patient parameters remotely from the hospital in an outpatient setting (telemonitoring or home monitoring). Certain problems can be detected quickly in this way, sometimes without the patient experiencing any discomfort yet. These problems can then be treated more quickly and correctly.
The following topics can be followed:
In case of changes in any of these parameters, the patient will be contacted for timely and correct adjustments in therapy and, if necessary, early follow-up with the general practitioner or cardiologist to prevent further deterioration, hospitalization or mortality.
Unfortunately, the systematic use of telemonitoring in heart failure varies considerably between hospitals, mainly due to the lack of a structural, legal and financial framework (reimbursement) for telemonitoring currently provided by the government.
Telemonitoring for patients with heart failure (reimbursed from 01-01-2025 in Belgium)
What?
Telemonitoring of weight, blood pressure and heart rate or of invasively measured pulmonary pressures (via the CardioMEMS or Cordella device – note: these devices themselves are not yet reimbursed in Belgium) via a digital platform.
Unfortunately, there is still no legal framework or reimbursement for telemonitoring of pacemakers, CRT and ICD devices.
Who?
This telemonitoring is only reimbursed for patients who were recently hospitalized for cardiac decompensation requiring intravenous diuretics. Telemonitoring may be started no later than 2 weeks after this hospitalization. There must have been at least 1 physical consultation or treatment session, in which the healthcare provider and the patient were at the same location.
How?
The patient, with or without the help of someone else, measures the weight, heart rate, blood pressure and/or the invasive pressure of the pulmonary artery every day at approximately the same time. Various digital systems can be used to send the monitored parameters to a digital platform. This can be done with automatically connected devices that automatically send the data to the telemonitoring team, without the patient having to do anything extra. If no automatically connected devices are used, the data are entered into the telemonitoring system by the patient via an app and then sent to the telemonitoring team.
Telemonitoring team
The telemonitoring is started from the hospital by a team of a heart failure cardiologist and a heart failure nurse. The hospital must first apply for recognition from the RIZIV. The heart failure nurse involved must have followed the postgraduate training to become a heart failure nurse. This is organised annually in collaboration with the Belgian Heart Failure Nurses, the Belgian Working Group on Cardiovascular Nursing and the Belgian Working Group on Heart Failure. Read more (NL).
Each hospital that uses this telemonitoring must have monitored at least 50 patients annually.
Follow-up
The evolution of these parameters is monitored by the team every working day during working hours. In case of abnormal values or in case of need for titration of the heart failure therapy, the patient is contacted at the latest the next working day to adjust the therapy, either by telephone advice or by an earlier check-up at the hospital or with the general practitioner. In patients with HFrEF, the recommended target doses of the neurohormonal blockers and the lowest dose of diuretics at which euvolemia is maintained are aimed for as soon as possible.
This telemonitoring is therefore not a continuous monitoring or alarm center. In case of acute problems or if the patient does not feel well, he or his environment should immediately contact the GP, cardiologist or heart failure nurse.
The GP is kept informed of important developments and/or adjustments to the treatment within 48 hours via electronic reports.
How long?
Telemonitoring is used during the transition phase until the clinical condition of the patient has stabilized. After a few months, it can be decided to stop telemonitoring of weight, blood pressure and heart rate. In more serious heart failure with a chronic need for adjustment of the heart failure medication based on fluctuating parameters, this telemonitoring can also be continued for a long time.
