Abstract
Background: Heart failure (HF) is a leading cause of morbidity, mortality, and healthcare burden globally. Internet of things (IoT)-based remote patient monitoring (RPM) systems have potential for enhanced care through continuous data collection and timely interventions, yet their adoption and implementation remain inconsistent due to multifaceted barriers, including technological, organizational, and patient-related challenges. This study aimed to develop and validate a conceptual framework for evaluating the adoption and implementation of IoT-based RPM systems in the management of HF, drawing on systematic evidence synthesis and expert consensus.
Methods: A two-phase study was conducted including: (1) a PRISMA-guided systematic review of literature from PubMed, Web of Science, Scopus, Embase, and IEEE Xplore databases up to May 1, 2025, focusing on adoption, barriers, facilitators, and outcomes and (2) a three-round modified Delphi consensus process with 22 multidisciplinary experts (cardiologists, health informaticists, telehealth managers, and policy experts) to validate and prioritize factors.
Results: The systematic review included 23 studies, identifying key barriers (e.g., connectivity issues, digital literacy deficits, and provider workload) and facilitators (e.g., user-friendly interfaces, patient education, and multidisciplinary collaboration) across technological, patient-related, organizational, and systemic domains. High feasibility and patient satisfaction (75–96% adherence) were noted, alongside clinical benefits such as reduced hospitalizations (19%) and emergency visits (28%). The Delphi process achieved strong consensus (Kendall’s W=0.82) on 30 core factors in five domains, with top priorities including user-friendly interfaces (95% rated highly important), patient education (92%), and reliable connectivity (90%).
Conclusion: This evidence-based conceptual framework provides a multidimensional guide for stakeholders to promote sustainable adoption of IoT-based RPM in the management of HF, emphasizing interconnected domains and prioritized interventions to overcome barriers and enhance patient outcomes, self-management, and healthcare efficiency.