Implementation of remote patient management for heart failure was associated with a higher nursing workload, with no observed differences in cardiologists' consultations or patient outcomes.
Key Findings
Results
RPM patients had significantly higher total consultation frequency and duration compared to both usual care groups.
Mean consultation frequency: hospital 1 RPM 18.5 (SD 9.3) vs hospital 1 UC 9.3 (SD 6.0) and hospital 2 UC 11.6 (SD 6.3); P<.001
Mean consultation duration: hospital 1 RPM 233.2 min (SD 95.2) vs hospital 1 UC 121.2 min (SD 47.9) and hospital 2 UC 113.0 min (SD 66.0); P<.001
Total of 131 patients included: hospital 1 RPM (n=34), hospital 1 UC (n=64), hospital 2 UC (n=33)
Follow-up period was 1 year, with patients included between June 2021 and July 2022
Results
The increase in consultations in the RPM group was driven primarily by nurse practitioner contacts, not cardiologist contacts.
Mean nurse practitioner consultations: hospital 1 RPM 15.3 (SD 8.4) vs hospital 1 UC 5.3 (SD 2.4) and hospital 2 UC 8.6 (SD 6.1); P<.001
Cardiologist number of consultations showed no significant difference across groups (P=.43)
Cardiologist care time showed no significant difference across groups (P=.27)
RPM implementation redistributed provider responsibilities toward nurse practitioners specialized in HF care
Results
HF-related readmissions did not differ significantly between RPM and usual care groups.
No significant difference in HF-related readmissions was observed (P=.47)
This finding was based on a retrospective cohort study using real-world clinical registry data
The study was not powered as a randomized controlled trial and was exploratory in nature
The sample sizes were relatively small (RPM group n=34), which may limit the ability to detect outcome differences
Methods
Two hospitals in the same regional care network with aligned care pathways were compared to isolate the effect of RPM implementation.
Hospital 1 had both an RPM cohort and a usual care cohort; hospital 2 had only a usual care cohort
The design allowed for both between-hospital and within-hospital comparisons
Cardiac health care consumption was quantified by number and duration of consultations (in-person, phone, and RPM)
Data were drawn from a clinical registry with a 1-year follow-up period
Discussion
The authors concluded that real-world RPM implementation requires optimization at organizational and technological levels.
Despite positive clinical outcomes demonstrated in RCTs, real-world workload implications remained unclear prior to this study
The study highlights redistribution of provider responsibilities as a key implementation challenge
Authors underscore 'the importance of real-world evaluation of the implementation of innovations'
Findings suggest that increased nursing workload without corresponding reduction in other care metrics may indicate inefficiencies in current RPM workflows
What This Means
This research suggests that adding remote patient monitoring (RPM) technology to heart failure care — where patients track daily health data at home and transmit it to their care team — significantly increases the workload of specialized heart failure nurses. In this study, patients using RPM had roughly twice as many consultations and spent about twice as many minutes in contact with their care team compared to patients receiving standard care, and this difference was almost entirely driven by increased nurse contacts rather than more cardiologist involvement. Despite this extra effort, there was no measurable difference in hospital readmissions for heart failure between the groups.
This research matters because it shows a gap between what remote monitoring promises in controlled research trials and what actually happens when it is rolled out in everyday clinical settings. While RPM is designed to catch worsening symptoms early and prevent hospitalizations, in practice it appears to generate a substantial amount of additional nursing work — such as reviewing transmitted data, following up on alerts, and communicating with patients — without a clear reduction in other types of care or in hospital admissions, at least in this relatively small sample.
The findings suggest that simply adding RPM technology to existing care pathways may not be enough; healthcare organizations may need to redesign workflows, clarify staff roles, and potentially use smarter filtering tools (such as automated alert systems) to manage the increased data flow efficiently. The study also highlights how important it is to study new health technologies in real-world settings, not just in carefully controlled trials, to understand their true impact on patients and healthcare staff.
Nieuwenhuys W, van Leunen M, van de Pol J, Hafkamp F, Spee R, Tio R, et al.. (2026). Real-World Impact of Remote Patient Management on Care Consumption and Care Time in Heart Failure: Retrospective Cohort Study.. JMIR formative research. https://doi.org/10.2196/89187