A frailty-based strategic planning framework for adaptive remote monitoring in older adults with heart failure (Preprint)

UNSTRUCTURED Remote monitoring is now a central pillar of digital health strategies worldwide, yet most programmes still rely on uniform technological models that do not reflect the complexity and heterogeneity of aging populations. Older adults with heart failure differ widely in functional reserve, cognition, comorbidity burden, and care preferences—differences driven largely by frailty. Despite its relevance, frailty is rarely considered in the strategic planning or operational design of digital health initiatives. As a result, remote monitoring systems often underperform in the very populations that stand to benefit the most, particularly frail or palliative individuals. This Viewpoint proposes a frailty-based strategic planning framework for remote monitoring, grounded in digital health principles, geriatric expertise, and real-world implementation experience. We outline four distinct profiles—robust, prefrail, frail, and palliative—and describe how each requires differentiated monitoring goals, alert thresholds, workflow structures, and caregiving support. Rather than viewing remote monitoring as a single technological intervention, we conceptualize it as a segmented, adaptive strategy embedded within broader care pathways. We also describe key operational components that shape success, including symptom-based self-reporting supported by caregivers or nurses, algorithm-generated alerts, structured triage processes, and rapid access to day-hospital reassessment. These elements illustrate a broader insight from digital health transformation: technology alone is insufficient; outcomes depend on the strategic planning, governance, workforce design, and organizational readiness surrounding it. Digital equity is another central dimension of this framework. Older and frail adults are often excluded from digital health due to presumed technological limitations. Yet when interfaces are simplified, caregiver participation is enabled, and workflows are adapted, these individuals can successfully engage with remote monitoring. Incorporating frailty into strategic planning is therefore essential for designing inclusive and equitable digital health ecosystems. Finally, we outline implications for health systems and policymakers, including segmentation-based program design, resource allocation, continuous portfolio management, and integration of geriatric expertise into digital health governance. A frailty-adaptive approach may allow remote monitoring programmes to achieve greater clinical relevance, scalability, and alignment with patient goals. By reframing remote monitoring as a frailty-responsive strategy rather than a uniform technological solution, this Viewpoint offers a strategic blueprint to guide digital transformation efforts in aging populations and to promote more person-centred, sustainable, and equitable digital health models.