Home monitoring should be the central element in an effective program of heart failure disease management.

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 costeffectively 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.