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Heart failure

A deepening digital divide in cardiovascular disease management

Nature Reviews Cardiology volume 22, page 918 (2025)Cite this article

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Heart failure is a debilitating disease with no cure and poor prognosis. The global increase in both the incidence and prevalence of heart failure, including in low-income and middle-income countries, stems from unmanaged risk factors, such as hypertension and diabetes mellitus, as well as from ageing populations. A key focus in heart failure management must be to reduce hospital readmissions and maximize the health and wellbeing of patients. Digital health that incorporates mobile applications, wearables and telemedicine is increasingly integrated into the care of patients with heart failure to improve symptom monitoring and management, communication and health-care access. However, although these technologies offer great potential to improve clinical outcomes, their long-term effectiveness and cost-effectiveness are still uncertain.

The first large-scale trial to investigate the effects of telemonitoring on heart failure outcomes was conducted by Sarwat Chaudhry and colleagues. The investigators randomly assigned 1,653 patients with a recent hospitalization for heart failure to daily home telemonitoring calls or usual care. Although remote monitoring was integrated into real-world care workflows, the strategy did not reduce the 6-month composite measure of hospital readmission or death compared with usual care. However, as indicated by the investigators, the intervention would have been more effective if contact between clinicians and patients had been more frequent. The study highlighted that effective digital health programmes need to facilitate clinician–patient interaction, not just transmit data, and emphasized the need for human-centred design, adaptive engagement and practical implementation.

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Acknowledgements

We are grateful to Brian Oldenberg (NHMRC CRE, Baker Heart and Diabetes Institute, Australia) for his careful review of the manuscript and insightful suggestions before submission.

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Authors and Affiliations

  1. School of Sociology and Population Studies, Nanjing University of Posts and Telecommunications, Nanjing, China

    Lu Yang

  2. NCD and Implementation Science Lab, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia

    Lu Yang & Abha Shrestha

  3. School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia

    Lu Yang & Abha Shrestha

  4. Dhulikhel Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal

    Abha Shrestha

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  1. Lu Yang
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  2. Abha Shrestha
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Correspondence to Lu Yang.

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Yang, L., Shrestha, A. A deepening digital divide in cardiovascular disease management. Nat Rev Cardiol 22, 918 (2025). https://doi.org/10.1038/s41569-025-01206-2

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