Heart failure (HF) is a multi-faceted, complex clinical syndrome characterized by significant morbidity, high mortality rate, reduced quality of life, and rapidly increasing healthcare costs. A larger proportion of these costs comprise both ambulatory and emergency department visits, as well as hospital admissions. Despite the methods used by telehealth (TH) to improve self-care and quality of life, patient outcomes remain poor. HF management is associated with numerous challenges, such as conflicting evidence from clinical trials, heterogeneity of TH devices, variability in patient inclusion and exclusion criteria, and discrepancies between healthcare systems. A growing body of evidence suggests there is an unmet need for increased individualization of in-hospital management, continuous remote monitoring of patients pre and post-hospital admission, and continuation of treatment post-discharge in order to reduce re-hospitalizations and improve long-term outcomes. This review summarizes the current state-of-the-art for HF and associated novel technologies and advancements in the most frequently used types of TH (implantable sensors), categorizing devices in their preclinical and clinical stage, bench-to-bedside implementation challenges, and future perspectives on remote HF management to improve long-term outcomes of HF patients. The Review also highlights recent advancements in non-invasive remote monitoring technologies demonstrated by a few pilot observational prospective cohort studies.

Background/Objective: Optimization of needle characteristics for trans-septal puncture is of paramount importance to reduce the extent of tissue deformation. This was achieved by studying the mechanical behavior of fossa ovalis (FO) in lamb hearts. The fossa ovalis tissue samples obtained after dissection were subjected to experimental indentation and tensile tests to determine tissue deformation. Methods: Lamb hearts (n = 20) were dissected to obtain fossa ovalis tissue samples. These were subjected to indentation and tensile tests to determine the puncture and rupture forces respectively. Indentation tests were performed using two different indenters: A steel indenter with a hemispherical tip and a Brockenbrough (BRK) needle (bevel tip). Tensile tests were formed using Zwick Roell (Z005) tensile machine at 100 N load cell. ImageJ analysis was also performed to determine the diameter and shape of FO. Results: Indentation results demonstrated that the hemispherical indenter requires a greater punch force compared to the puncture force with the BRK needle. The mean punch force of the hemispherical indenter (15.57 N) was nearly 3 times greater than the puncture force of the BRK needle (5.47 N). Variations between the two indenters provide an insight into the importance of device geometry on trans-septal procedures. The tensile test results illustrated a typical failure pattern with a toe region, linear region, and failure region. The mean rupture force determined was 10.51 N. ImageJ analysis confirmed an oval shape of FO and the diameters measured were in the range 9.0–15.3 mm. Conclusions: The mechanical aspects of fossa ovalis in lamb hearts were successfully studied through a series of experimental indentation and tensile tests. This study serves as a guide to dissecting the challenging FO sample. The procedures for indentation and tensile tests are detailed with common experimental challenges encountered addressed. The correlation of the parameters involved in these experimental tests to the collagen fiber orientation in tissues is also discussed, providing an insight into the deformation of tissues and variations in fiber orientation before and after trans-septal procedures.