My View - RPM enables better heart failure care

VIEW - Daman Kaur, nurse practitioner in cardiology at Te Whatu Ora Hawke’s Bay

At the 2025 CSANZ Annual Scientific Meeting in Rotorua, our cardiology team presented a new model of care that’s transforming how we manage heart failure in Hawke’s Bay. 

The key to this transformation? Remote patient monitoring (RPM), which has allowed us to up-titrate heart failure medications more quickly, safely, and efficiently—while improving outcomes for patients and easing pressure on the staff. 

Why rapid titration matters 

For several years, cardiologists in New Zealand have been calling for an appropriate model of care to support patients transitioning from hospital to the community and to facilitate subsequent rapid titration of guideline directed medical therapy (GDMT) for optimal treatment. 

Heart failure patients need to be started and up-titrated on GDMT quickly after discharge to reduce symptoms, hospitalisation, and death. But the traditional model of care (with in-person clinics) is resource heavy and has struggled to deliver this. 

Many factors impact a patient’s ability to engage with the old model of care, including geographic barriers, rural or remote living, work obligations, and whānau responsibilities. In addition, the traditional model is resource-intensive and time-consuming—relies heavily on patient travel and is constrained by limited appointment availability.

This often means it takes many months to reach target doses, increasing mortality and morbidity. RPM changes that. 

How RPM works 

With our innovative new model of care, patients are given a 4G-enabled tablet paired with preconfigured health monitoring devices: scales, blood pressure monitors, thermometers, and pulse oximeters. 

The tablets are locked down for health use only, with no need for the patient to provide internet, download apps, or use their own phone. The kit (made by NZ company Spritely) is simple and takes just a few minutes to initiate and personalise for each patient.

The RPM system collects vital signs and symptom reports daily (even intra-daily if needed). It also supports secure messaging, video calls for remote consultations, and educational content. 

Because patients do not have to come into the clinic for every adjustment, we can assess medication tolerance remotely and up-titrate more frequently and confidently. Clinicians can set individual parameters and if readings are outside those parameters, they get alerted. 

We do not need to review all patient data daily or take on additional work. We receive alerts when intervention is needed and can set up a service-specific action plan—for example, prompting patients to contact us directly via the device. 

The rest of the care follows our usual weekly or fortnightly clinic rhythm, but without the need for travel. Patients complete their observations at home, freeing up our time for other clinical tasks or documentation. 

The results 

The difference this has made is substantial. 

• Patients supported by RPM complete their medication titration in 6–8 weeks, compared to 6–8 months under traditional care. 
• Their 30-day hospital readmission rate is 0 percent, compared to 25 percent for patients not using RPM. 
• Missed appointments have dropped to 0 percent (versus 15.3 percent for in-person clinics). 
• Each patient enrolled in the RPM model is saving the health system approximately $9,500. 

To date, our team has saved more than $250,000 and more than 50 bed nights with each new enrolment increasing these totals. 

Working for patients and nurses 

From a patient perspective, using a dedicated tablet with pre-provisioned medical devices removes barriers to RPM and increases engagement. This approach standardises care with a common set of devices for all patients, eliminating the technology issues that plagued our previous attempts at RPM.

Since we began providing this model of care nearly two years ago patients have consistently praised the ease of use, convenience and immediacy of remote patient monitoring. 

From a nursing perspective, RPM is a game-changer. It gives us the clinical data we need to make safe, timely decisions—without having to wait for in-person clinics and rely on patient memory, or manual paperwork. Instead of waiting for the next clinic visit, we can check vitals and respond. 

Patients can ask for call-back. As clinicians, we have more clinical data to make decisions, which increases the safety and confidence for both patient and the clinician in the treatment. 

RPM also saves time. Because we are not spending hours coordinating appointments, chasing data, travelling to clinics (sometimes long distances) and dealing with no-shows, we can focus more on clinical care. 

The result is greater efficiency and less burnout, all while expanding our team’s capacity to manage more patients. 

Scaling the model of care

Our experience has shown remote care should be the default for managing stable heart failure patients, unless there is a clinical reason not to. A “remote-first” approach ensures more patients benefit from rapid titration reducing the overall burden on hospitals and staff. 

Scaling this model to more regions would save tens of millions per year. Nationally, the potential is even greater. With services under increasing pressure and staff in short supply, we cannot afford not to modernise how we deliver care. 

In Hawke’s Bay, we’ve shown that remote care can improve outcomes, reduce costs, and ease pressure on healthcare teams. We now have a nurse-friendly, patient-centred solution built right here in New Zealand, and it is delivering world-class results.

Remote patient monitoring isn’t just about technology, itis about giving clinicians better tools to do their jobs more efficiently, and giving patients a better chance at recovery. The sooner we can scale this up across the country the better.

Co-authored by K Dyson, M. Coghlan-Talbot, L. T. Nahu, S. Gardiner

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