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Heart failure (HF) is a major and growing public health problem in the United States. On the basis of current trajectories, it has been estimated that, over the next 20 years, the prevalence of HF will increase by 25%, from 2.8% to 3.5% of the population (Figure 1).1 The increased prevalence may be expected to contribute to an increase in annual direct medical costs from the present estimate of $24.7 billion to approximately $77.7 billion, in 2008 dollars. At the same time, indirect costs—that is, costs related to lost productivity due to morbidity and mortality—may be expected to increase from $9.7 to $17.4 billion. If current legislative and regulatory efforts are successful at expanding healthcare access while improving affordability, systematic approaches must be developed and implemented to drive cost-effectiveness. The management of patients with HF will be front and center in efforts to achieve this goal. Although many questions remain, extensive research performed to date indicates that certain disease management interventions cost-effectively improve clinical outcomes in patients with HF. Home monitoring—providing continuity of patient assessment and care beyond the hospital and conventional ambulatory settings—has been central among the elements of these programs.Figure 1. Twenty-year projections for United States heart failure prevalence and associated direct medical costs based on current trends. Adapted from Heidenreich et al1 with permission of the publisher.Response by Desai on p 827### Heart Failure Disease Management and Home MonitoringHome monitoring has been integral to most HF disease management programs, with demonstrable clinical benefit in randomized, controlled trials. A proposal for categorizing the generic components of disease management programs2 may be applied to define the elements of a HF program as 1) optimizing treatment prescriptions; 2) patient and caregiver education—including adherence to medication and dietary recommendations, self-monitoring, and connectivity to a healthcare provider; and 3) ongoing monitoring and responsiveness to …

Home Monitoring Should Be the Central Element in an Effective Program of Heart Failure Disease Management