Perspective:

The care of HF patients has become increasingly complex in light of newer pharmacotherapies, devices, and lifestyle-based interventions. There has been growing concern that telemedicine will be unable to scale to meet the needs of HF patients given its resource-intensive nature and the growing prevalence of HF in the United States. There has thus been interest in using mobile health technologies to enable HF telemonitoring at scale. In meta-analyses, mobile health technologies deployed for HF monitoring and treatment engagement have improved HF outcomes, including symptoms, patient self-management, HF hospitalizations, and mortality. While the current trial failed to meet its clinical endpoints, it did lead to improvements in HF self-care.

Strengths of the MESSAGE-HF trial include the extended duration of follow-up relative to prior mobile health trials (6 months), deployment at a population level, and the collection of important process measures necessary to understand the impact of the intervention on clinical workflow (e.g., number of downstream telephone calls). Important limitations of the trial are worth noting, however. First, a large portion of the intervention was focused on physiologic monitoring to detect early decompensation. A growing body of literature, however, supports moving beyond physiologic monitoring and incorporating behavior change strategies into mobile health interventions. Second, participants in the trial may not be generalizable to the larger population of HF patients. Of note, almost all participants were on optimal guideline-directed medical therapy, which is rarely observed in contemporary observational studies and clinical trials in HF.