Frailty-Based Remote Monitoring in Older Adults With Heart Failure: Conceptual Framework for Adaptive Digital Health Strategies

Unlabelled: Remote monitoring is increasingly used in heart failure care, but most programs rely on uniform models that insufficiently reflect the heterogeneity of older adults, particularly with respect to frailty, cognitive impairment, functional dependency, and caregiver availability. This viewpoint argues that frailty should be considered a central determinant of remote monitoring design in older adults with heart failure, rather than a secondary modifier of conventional digital health pathways. Drawing on evidence from heart failure telemonitoring, geriatric medicine, and real-world cardiogeriatric experience, we propose a frailty-adaptive framework structured around four clinical trajectories: robust, prefrail, frail, and palliative. Each trajectory is associated with distinct monitoring objectives, workflow adaptations, and response pathways. Robust patients may benefit primarily from optimization, self-management support, and guideline-directed therapy titration; prefrail patients from early detection of deterioration and functional decline; frail patients from proxy-supported reporting, nurse-led triage, and rapid-access cardiogeriatric reassessment; and palliative patients from simplified symptom-guided monitoring focused on comfort, hospitalization avoidance, and caregiver support. This framework reframes remote monitoring as a stratified clinical process rather than a purely technological intervention. By aligning digital strategies with frailty status, functional capacity, and care goals, frailty-adaptive remote monitoring may improve clinical relevance, promote digital health equity, and support more sustainable models of care for older adults with heart failure.