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Home Monitoring in Cardiology: A New Era of Patient Care

Posted on Tuesday January 14, 2025 in Naked Heart

An article written by Dr Edward Leatham, Consultant Cardiologist

Tags: BP, CGM, Glucose, Telehealth, Homecare, NH1  search website using Tags to find related stories.

Over the past decade, healthcare has experienced a remarkable evolution in how patients are monitored and managed remotely. Although the Covid-19 pandemic may have accelerated this trend, it is clear that even before the pandemic—when visits to see the doctor occasionally became nigh on impossible—modern technology was already paving the way for clinicians, particularly cardiologists, to care for their patients within the comfort of their own homes. By sending biometric and medical data through various monitoring devices to user-friendly dashboards, cardiology teams have been able to watch over patients without necessarily requiring them to come to clinic. This approach offers immense benefits: it minimises physical travel to the hospital or clinic, ensures timely interventions for emerging issues, and empowers patients to take greater responsibility for their own health.

In this article, we will explore how home monitoring has transformed cardiology services, which devices and technologies are leading this transformation, the associated challenges, and what the future holds. We will also discuss how these approaches are gradually being integrated into clinical practice in the UK, how the concept of remote monitoring fits into the broader healthcare economy, and how these developments are reshaping the relationship between patients and healthcare providers.

1. The Context: Cardiology Before and After Covid-19

Before the Pandemic
Even before the Covid-19 pandemic, the shift towards remote home monitoring in cardiology had begun. The pressures of chronic diseases, including hypertension, heart failure, and various forms of arrhythmias, meant that healthcare systems were already recognising the need for more efficient ways to manage large numbers of patients. Traditional outpatient appointments often required weeks or months of waiting, costly travel, and resource-intensive clinic visits for both patients and healthcare professionals. As wearable devices and remote monitoring platforms became more affordable and more widely trusted by clinicians, the stage was set for a gradual adoption of digital healthcare.

During and After the Pandemic
The pandemic highlighted the practical advantages of remote monitoring. Clinics and hospitals faced sudden restrictions on face-to-face contact, increasing the risk for vulnerable and high-risk patients. Since cardiology patients often require more vigilant follow-up—particularly if they have unstable heart conditions—there was a pressing need to ensure clinical oversight remained consistent. Remote monitoring, harnessing modern technology, rose to the challenge. Devices ranging from implantable cardiac monitors to simple wrist-worn sensors began transmitting data to “dashboards,” giving cardiologists real-time or near real-time insights into parameters such as heart rate, rhythm, blood pressure, and even blood glucose.

2. Implantable Devices: A Longstanding Pioneer

The Implantable Loop Recorder
One of the earliest innovations in cardiology for remote monitoring was the implantable loop recorder, such as Medtronic’s Reveal LINQ™ device (often referred to simply as “Link” in daily practice). These devices monitor heart rhythms, detecting atrial fibrillation, pauses, and other serious arrhythmias, and then transmit the data to designated centres via secure data networks. As a result, cardiologists can quickly spot when a patient has had an arrhythmic episode. Traditional event monitors or Holter monitors used in short bursts had limitations in detecting infrequent arrhythmias, while an implantable loop recorder can continue monitoring for years.

Implantable Cardiac Defibrillators and Advanced Pacemakers
Similar remote monitoring technologies have been integrated into sophisticated implantable devices such as the implantable cardiac defibrillator (ICD) and advanced cardiac resynchronisation therapy pacemakers (CRTs). These devices not only keep the heart beating regularly but also have built-in algorithms to detect impending decompensation—early warning signs of heart failure or other significant events. By alerting clinicians in a timely manner, remote transmissions allow care teams to intervene before a patient’s condition deteriorates so severely that an emergency hospital admission becomes necessary.

3. Wearable Technologies and the Rise of Consumer-Grade Devices

One of the biggest shifts in the last few years is the proliferation of lower-cost, wearable devices suitable for home use. These range from consumer electronics worn on the wrist to discreet patches and smartphone-enabled tools. Because of the pandemic’s influence and the rapidly changing technology landscape, many cardiologists are now open to partnering with patients who use consumer-grade wearables—albeit with caution and an understanding of their limitations.

1) Blood Pressure Monitors
Arguably the most common and well-established home monitoring tool is the home blood pressure monitor. Hypertension is one of the world’s most prevalent medical conditions, and accurate readings are essential to inform therapy adjustments. Historically, office readings could be misrepresentative because of “white-coat hypertension,” in which a patient’s blood pressure is elevated solely due to the stress of being in a medical setting. Home monitors allow for repeated measurements over time in a more relaxed environment.

Over the years, new devices with automatic data transmission have emerged. Patients can send a digital record or PDF summary of their readings directly to their clinician, avoiding the need to transcribe values. While the gold standard remains the traditional 24-hour ambulatory blood pressure monitor used in many clinical trials, certain continuous monitors have gained favour for ease of use. One such development is the continuous blood pressure monitor band produced by Aktiia, worn on the wrist, which collects blood pressure data continuously. Patients then have the option to email their physician a PDF report, or in some cases, subscribe to a model where the data populate a dashboard at the doctor’s practice. This process helps clinicians make quicker, more informed decisions about medication adjustments and lifestyle advice.

2) Home ECG Monitors
For more than a decade, at-home ECG monitors have allowed cardiologists and GPs to check for arrhythmias without an in-clinic test. Early devices, such as the Omron Heart Scan, introduced the idea of a patient-activated ECG that could be brought into the clinic for analysis. More recently, smartphones, watches and app-based solutions—like Kardia , Apple watch and Withings —have made it possible for patients to take a 30-second single-lead ECG, which is then analysed by the device’s software to detect atrial fibrillation or other simple arrhythmias. The advantage lies in convenience and immediate feedback for patients, although single-lead ECGs cannot always differentiate between more complex arrhythmias, such as ventricular tachycardia or atrial flutter, and a normal sinus rhythm with occasional ectopics. Despite these limitations, these technologies have made it much easier for patients to record and share ECGs with their healthcare provider.

3) Continuous Glucose Monitors (CGMs)
Although CGMs have long been used in the management of diabetes, they are now catching the attention of cardiologists and heart failure specialists. Research shows that wide fluctuations in blood glucose can have significant cardiovascular implications, even in patients not formally diagnosed with diabetes. Continuous monitoring provides insight into how a patient’s glucose levels respond to diet, medications, and exercise throughout the day. Devices such as the FreeStyle Libre or Dexcom systems can transmit readings via smartphone apps directly to clinicians. As newer classes of glucose-lowering medications show promise in reducing cardiovascular and heart failure risk, there is growing interest in how CGMs can be incorporated into routine cardiology follow-ups.

4) Weight Monitoring for Heart Failure
For patients with heart failure, fluid management is critical. Weight changes can indicate fluid retention or overload, often preceding overt symptoms such as breathlessness or significant swelling. An accurate set of home scales, alongside a daily record, can alert clinicians to a developing problem before it becomes acute. Many digital scales now automatically upload readings via Wi-Fi or Bluetooth to an app, making data sharing seamless. This practice forms part of the core self-management plan for many heart failure patients, allowing them (under clinical guidance) to adjust their diuretic dosage according to weight changes.

4. The Data Challenge: Too Much Information?

While these technologies have enormous potential, the transition to widespread remote monitoring has not been entirely smooth. One of the early criticisms involved the sheer volume of incoming data. Every home blood pressure measurement, ECG recording, or blood glucose reading could theoretically be emailed in real time to an already busy clinician. Patients sometimes mistakenly believe that each reading is reviewed individually, expecting immediate feedback. This is obviously impractical, and it can create anxiety if the patient sees results that appear abnormal without proper clinical interpretation.

Filtering and AI-Driven Analysis
To address this, many solutions incorporate automated filters, trend analyses, and alerts that are only triggered when a significant deviation is detected. Increasingly, artificial intelligence (AI) algorithms are embedded within the dashboards. For instance, in an ECG monitoring scenario, if a patient’s recordings over a 24-hour period remain within normal limits, the system may summarise this as “No abnormalities detected,” flagging only the 1% that do show concerning patterns for clinician review. This approach reduces the burden on medical staff, ensuring they focus on data points that matter.

Implications for Healthcare Funding
Another challenge is the question of reimbursement: in the UK, there are very few NHS or private insurance frameworks that fully cover the costs of remote monitoring. In the United States, reimbursement codes exist for many remote monitoring services, making the business case more robust. Despite the NHS moving towards value-based care initiatives, the funding mechanisms for home monitoring programmes are still evolving. If these technologies prove to reduce hospital admissions, shorten waiting times, and improve health outcomes, one can expect an eventual increase in acceptance and coverage by payers.

5. Integrating Data into a Single Dashboard

An important missing ingredient in many healthcare settings is a unified platform that can pull data from various devices into a single, user-friendly dashboard. Patients might measure their blood pressure with one device, ECG on another, continuous glucose with a separate app, and weight from a digital scale. For the clinician, toggling between multiple portals is inefficient. Similarly, from a patient’s perspective, it is disjointed to deal with multiple apps or websites.

Several software developers are now racing to solve this issue. The goal is a platform capable of integrating multiple metrics—blood pressure, glucose, heart rate, ECG data, and weight—into one display. Ideally, it should also be bidirectional, allowing the clinician to set thresholds for alerts (for example, a certain percentage rise in weight or consistently elevated glucose readings) and automatically notify both patient and clinician. A robust platform will also have AI-driven analytics, generating automated summaries or “red flags” to guide the physician’s attention to where it is needed most.

6. Patient Empowerment and Self-Management

One of the great successes of the remote monitoring movement is the empowerment of patients to take ownership of their health. Rather than being passive recipients who visit the clinic only when told, patients can track their data in real time and gain deeper insight into how medications, diet, and lifestyle changes impact their condition. This shift in mindset—from mere compliance to active participation—can be a game-changer for long-term outcomes.

For instance, a person with heart failure might become more attuned to daily changes in weight and notice that a slight upward trend could foreshadow increased fluid retention. That patient can then adjust their diuretic or contact the heart failure clinic for advice rather than waiting until they feel severely breathless. Similarly, a patient with hypertension who sees rising readings on their Aktiia band might decide to reduce salt intake or adhere more carefully to their medication regimen. This kind of immediate feedback loop encourages continuous behaviour change, rather than the intermittent approach that comes with infrequent clinic visits.

7. Practical Considerations and Implementation in Clinical Practice

Selecting the Right Tools
In clinical practice, choosing which monitoring tools to recommend is partly dictated by a patient’s condition. A patient with well-controlled hypertension might only require a standard home monitor, occasionally emailing results. Another patient with a history of paroxysmal atrial fibrillation might benefit more from a handheld ECG tool like Kardia. Someone in more advanced heart failure may need a combination of weight monitoring and a wearable device for daily biometrics. Tailoring the device to the patient’s needs—while considering their level of tech-savviness—is critical.

Educating Patients and Caregivers
Effective home monitoring requires initial training so that patients (and in some cases, caregivers) understand how to use devices, interpret basic data, and know when to contact their healthcare provider. Written instructions, video tutorials, and telehealth check-ins can help. It is essential to set realistic expectations: not every single data point will be evaluated by a professional, and patients should understand the thresholds or alerts built into the system.

Building a Workflow
For clinicians, establishing a workflow for remote data review is essential. Who checks the data? How often? How are abnormal or urgent readings flagged and escalated? Some practices allocate specific staff—nurses, physician associates, or technicians—to oversee the dashboards and highlight concerning trends. Doctors can then review these flagged entries and make clinical decisions. This structured approach ensures that remote monitoring data do not become an unmanageable flood of information.

8. Overcoming Barriers: Funding and Regulation

NHS Pathways
As of now, the NHS does not have widespread frameworks for reimbursing or funding remote monitoring. While pilot schemes and digital health initiatives exist, there is no universal mandate. However, the potential long-term cost savings and improved patient outcomes make it likely that more formalised pathways will emerge. Remote monitoring can reduce hospital admissions, particularly for chronic conditions like heart failure or arrhythmias that can deteriorate rapidly without early intervention.

Private Insurance and Self-Funding
In private practice, some insurers are beginning to see the value in covering remote monitoring devices or associated telehealth appointments. Still, adoption is patchy. Patients keen on the benefits of home monitoring sometimes self-fund these devices, especially if they see an immediate advantage in having real-time updates on their cardiovascular status. Over time, if enough data demonstrate better outcomes at lower cost, it is reasonable to expect more comprehensive reimbursement policies to follow.

Regulatory Approvals
Any medical device in the UK must comply with the relevant standards, overseen by bodies like the Medicines and Healthcare products Regulatory Agency (MHRA). Wearable blood pressure monitors, ECG patches, and glucose monitors are typically subjected to clinical trials and evidence-based assessments. Therefore, recommended devices for remote monitoring must meet a certain threshold of reliability and accuracy.

9. The Future: AI, Virtual Coaching, and Personalised Care

AI Integration
As mentioned, one of the most exciting trends is the integration of artificial intelligence to analyse large volumes of patient data. Advanced algorithms can spot subtle trends long before a human clinician might. For instance, a slight upward drift in daily blood pressure readings might correlate with disrupted sleep patterns, or changes in glucose control might coincide with a new medication. An AI-driven system could alert the clinician and patient to these patterns with minimal delay.

Virtual Coaching
The next logical step is to add “virtual coaches” to the remote monitoring ecosystem. These digital platforms would not only display raw data but also prompt the patient with personalised lifestyle recommendations. For example, if a patient’s weight creeps up, the virtual coach might suggest a lower-sodium meal plan or remind the patient to take their diuretic. Over time, these insights become more tailored to each individual, helping them meet goals set by their clinician.

Personalised Medication Adjustments
Eventually, AI tools might be authorised to automatically recommend or even implement small medication titrations, overseen by a clinician. While this is not a reality in most healthcare systems today, the groundwork is being laid. Already, some advanced insulin pumps for diabetic patients can adjust insulin delivery based on real-time glucose monitoring. In cardiology, we could see a future in which heart failure medication doses are fine-tuned based on daily weight, blood pressure, and symptoms, all under remote supervision.

10. A Model for the Future: Integrating Key Health Metrics

In many modern cardiology practices, each new patient is given a list of key metrics to track over time—such as blood pressure, heart rate, weight, and certain blood test results—along with target ranges. Ideally, these targets are shared with the patient’s GP, ensuring continuity of care. With advanced remote monitoring systems, these key metrics would automatically feed into a single dashboard, complete with AI-driven analysis, alert thresholds, and integrated messaging platforms.

In this model:

  1. Patient-Centred Goals: The patient knows what they are aiming for (e.g., a systolic blood pressure of 130–140 mmHg, a stable weight, and a specific HbA1c target).
  2. Continuous Monitoring: The patient’s wearable or implantable device captures relevant data and uploads it to the dashboard.
  3. AI Screening and Summarisation: Software filters the data to highlight significant deviations from normal.
  4. Clinician Oversight: A designated healthcare professional reviews alerts. If necessary, they contact the patient to schedule a telehealth consultation or adjustment of therapy.
  5. Virtual Coaching: Between clinical touchpoints, a digital coach offers guidance on diet, exercise, and medication adherence, adapting to real-time data.

Such an integrated approach would reduce the number of in-person appointments, provide peace of mind for both patient and doctor, and potentially lead to better health outcomes. For funding bodies—whether that is the NHS, private insurance, or even self-pay—this could result in cost savings thanks to reduced hospital admissions and a more efficient use of healthcare resources.

11. Practical Example: A Typical Patient Pathway

Consider a 65-year-old patient with a history of hypertension and mild heart failure who has recently been diagnosed with prediabetes. In a traditional setting, they would have separate clinic visits to manage each condition: one for blood pressure checks, another for heart failure follow-up, and perhaps a separate diabetic review. They might also need occasional Holter monitor testing for arrhythmia surveillance.

In a home monitoring scenario, they could be equipped with:

  • A wrist-worn continuous blood pressure monitor (e.g., from Aktiia).
  • A Wi-Fi-enabled scale for daily weight tracking.
  • A single-lead ECG device like Kardia to record any symptomatic palpitations.
  • A continuous glucose monitor if needed for short-term or longer-term assessments.

All these devices would feed data to an integrated dashboard monitored by the heart failure nurse, the GP practice, and a cardiologist. If the patient’s weight rose by two kilograms over a few days, the system might generate an alert. A nurse could call to check if the patient had dietary indiscretions, missed diuretic doses, or was experiencing increased breathlessness. Early detection could avert an acute decompensation, thereby preventing an emergency admission.

12. The Business Case for Remote Monitoring

Reduced Office Visits and Admissions
When effectively implemented, remote monitoring can significantly reduce the frequency of unnecessary hospital visits. Cardiologists can allocate in-clinic time more efficiently, focusing on complex patients who truly need face-to-face evaluation. Moreover, if early interventions become the norm—prompted by real-time data—a significant portion of emergency heart failure admissions could be avoided. This not only saves healthcare costs but also spares patients the stress of hospital stays.

Increased Patient Satisfaction
Patients are increasingly tech-savvy and value convenience. The ability to send data electronically, receive feedback quickly, and reduce the burden of in-person appointments all contribute to higher patient satisfaction. Since chronic conditions often require lifelong management, a system that minimises disruption to daily life is particularly appealing.

Opportunities for Innovation
Numerous companies are entering the remote monitoring space, forging partnerships with healthcare providers. This competition drives innovation, pushing improvements in device accuracy, user interface design, and data security. Over time, these innovations will yield more affordable and more comprehensive solutions for remote care.

13. Conclusion: A New Standard of Care

Home monitoring has moved beyond a fleeting trend, evolving into a core element of modern cardiology. Even before Covid-19 enforced physical distancing and disrupted routine healthcare visits, remote monitoring was already changing how cardiologists and other healthcare professionals cared for patients with chronic conditions. The pandemic merely accelerated a shift that was inevitable, given the pressures on the healthcare system, the rise of digital technology, and the increasing acceptance of remote solutions.

Devices such as Medtronic’s implantable loop recorders, wearable ICDs, advanced CRT pacemakers, and consumer-grade technologies like Aktiia continuous blood pressure bands or Kardia ECG monitors have become integral parts of the modern clinician’s toolkit. For patients, the ability to measure and share vital signs—from blood pressure and weight to ECGs and glucose levels—can significantly enhance self-management, leading to better health outcomes and fewer acute crises.

Challenges remain, including data overload, the need for integrated dashboards, and funding mechanisms that lag behind technological progress. Yet as software developers refine platforms to incorporate AI-driven insights and user-friendly interfaces, and as healthcare stakeholders recognise the cost-effectiveness of proactive care, one can expect remote monitoring to expand further. Ultimately, it points to a future where cardiology care is both more personalised and more efficient, with patients and clinicians acting as partners in a continuous care model.

In Practice
In many UK cardiology clinics today, healthcare professionals are already selectively recommending home blood pressure devices, ECG monitoring tools, and weight logs for heart failure. While large-scale adoption of integrated platforms and AI solutions is still in development, the potential benefits are clear. In time, the seamless amalgamation of these technologies could reduce the number of face-to-face appointments, freeing up resources for the most critically ill patients. The result is a more streamlined, patient-focused healthcare system, where issues can be flagged and addressed promptly, and patients can enjoy peace of mind knowing their cardiologist is only a remote alert away.

The overarching message is one of empowerment. With the correct combination of devices, data integration, and clinical oversight, patients can transition from sporadic check-ups to a near-continuous dialogue about their cardiovascular health. This approach not only improves patient engagement and autonomy but also provides clinicians with valuable real-time insights that guide timely and precise interventions. As remote monitoring continues to gain traction, it promises to redefine our understanding of best practices in cardiology, making nigh on impossible clinic visits of the past a non-issue and ushering in a new era of truly patient-centred care.

For other stories related to cholesterol, coronary heart disease, and LDL, explore the archives by entering a tag under the search function above.

The Naked Heart is an educational project owned and operated by Dr Edward Leatham. It comprises a series of blog articles, videos and reels distributed on TiktokYoutube and Instagram  aimed to help educate both patients and healthcare professionals about cardiology related issues.

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