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Digital tools for remote consultations, monitoring, cardiac device interrogation and clinical decision support systems are now widely available. Digital health monitoring improves care quality, providing value to patients, healthcare professionals, hospitals and governments. This transformation is fostering a future where \u2018health\u2019 takes precedence over \u2018reactive care\u2019, driven by empowered patients and advanced technologies. Success in this transformation requires not only technology, but also new strategic operational models, optimised workflows and workforce redesign. Health systems that form partnerships with other stakeholders, such as peers, payers, start-ups, life sciences organisations, industries, will be better positioned to improve patient experiences and outcomes. This review examines digital solutions that optimise medical therapy prescriptions, promote patient engagement and address therapeutic inertia in AF, heart failure and coronary artery disease.<\/jats:p>","DOI":"10.15420\/ecr.2025.87","type":"journal-article","created":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T11:23:47Z","timestamp":1788780227000},"source":"Crossref","is-referenced-by-count":0,"title":["Rethinking Secondary Cardiovascular Prevention in the Digital Era: Patient Empowerment, Adherence and Optimisation of Guideline-based Care"],"prefix":"10.15420","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1297-2056","authenticated-orcid":false,"given":"Antonio","family":"Di Monaco","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03djvm380","id-type":"ROR","asserted-by":"publisher"}],"name":"Ospedale Generale Regionale Francesco 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Psycho-educational interventions and cardiac rehabilitation. In: Roncella A, Pristipino C, eds. Psychotherapy for ischemic heart disease. Cham, Switzerland: Springer, 2016; 107\u201320. https:\/\/doi.org\/10.1007\/978-3-319-33214-7_8.","DOI":"10.1007\/978-3-319-33214-7_8"},{"key":"ref24","doi-asserted-by":"crossref","unstructured":"Dusetzina SB, Besaw RJ, Whitmore CC, et al. Cost-related medication nonadherence and desire for medication cost information among adults aged 65\u00a0years and older in the US in 2022. JAMA Netw Open 2023;6:e2314211. https:\/\/doi.org\/10.1001\/jamanetworkopen.2023.14211; PMID:\u00a037200029.","DOI":"10.1001\/jamanetworkopen.2023.14211"},{"key":"ref25","doi-asserted-by":"crossref","unstructured":"FarzanehRad A, Allahbakhshian A, Gholizadeh L, et al. Randomized comparison of the effects of tailored text messaging versus pillbox organizers on medication adherence of heart failure patients. 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Expert Rev Cardiovasc Ther 2020;18:41\u201351. https:\/\/doi.org\/10.1080\/14779072.2020.1717335; PMID:\u00a031941396.","DOI":"10.1080\/14779072.2020.1717335"},{"key":"ref28","doi-asserted-by":"crossref","unstructured":"Nieuwlaat R, Schwalm JD, Khatib R, Yusuf S. Why are we failing to implement effective therapies in cardiovascular disease? Eur Heart J 2013;34:1262\u20139. https:\/\/doi.org\/10.1093\/eurheartj\/ehs481; PMID:\u00a023376448.","DOI":"10.1093\/eurheartj\/ehs481"},{"key":"ref29","doi-asserted-by":"crossref","unstructured":"Stone JA, Austford L, Parker JH, et al. AGREEing on Canadian cardiovascular clinical practice guidelines. Can J Cardiol 2008;24:753\u20137. https:\/\/doi.org\/10.1016\/s0828-282x(08)70679-2; PMID:\u00a018841253.","DOI":"10.1016\/S0828-282X(08)70679-2"},{"key":"ref30","doi-asserted-by":"crossref","unstructured":"Sabouret P, Puymirat E, Kownator S, et al. Lipid-lowering treatment up to one\u00a0year after acute coronary syndrome: guidance from a French expert panel for the implementation of guidelines in practice. Panminerva Med 2023;65:244\u20139. https:\/\/doi.org\/10.23736\/S0031-0808.22.04777-2; PMID:\u00a036222543.","DOI":"10.23736\/S0031-0808.22.04777-2"},{"key":"ref31","doi-asserted-by":"crossref","unstructured":"Marquis-Gravel G, Bhatia S, Brown V, Goodman SG. Care gaps and system issues with delivering cardiovascular risk reduction and lipid-lowering therapy in secondary prevention. Can J Cardiol 2024;40:S35\u201342. https:\/\/doi.org\/10.1016\/j.cjca.2024.05.010; PMID:\u00a039111898.","DOI":"10.1016\/j.cjca.2024.05.010"},{"key":"ref32","unstructured":"Fonarow GC. Strategies to improve the use of evidence-based heart failure therapies. Rev Cardiovasc Med 2005;6(Suppl 2):S32\u201342. PMID:\u00a015891703."},{"key":"ref33","doi-asserted-by":"crossref","unstructured":"D\u2019Amario D, Rodolico D, Rosano GMC, et al. Association between dosing and combination use of medications and outcomes in heart failure with reduced ejection fraction: data from the Swedish Heart Failure Registry. Eur J Heart Fail 2022;24:871\u201384. https:\/\/doi.org\/10.1002\/ejhf.2477; PMID:\u00a035257446.","DOI":"10.1002\/ejhf.2477"},{"key":"ref34","doi-asserted-by":"crossref","unstructured":"Reuter K, Genao K, Callanan EM, et al. Increasing uptake of depression screening and treatment guidelines in cardiac patients: a behavioral and implementation science approach to developing a theory-informed, multilevel implementation strategy. Circ Cardiovasc Qual Outcomes 2022;15:e009338. https:\/\/doi.org\/10.1161\/CIRCOUTCOMES.122.009338; PMID:\u00a036378766.","DOI":"10.1161\/CIRCOUTCOMES.122.009338"},{"key":"ref35","doi-asserted-by":"crossref","unstructured":"Flu HC, Tamsma JT, Lindeman JHN, et al. A systematic review of implementation of established recommended secondary prevention measures in patients with PAOD. Eur J Vasc Endovasc Surg 2010;39:70\u201386. https:\/\/doi.org\/10.1016\/j.ejvs.2009.09.027; PMID:\u00a019910222.","DOI":"10.1016\/j.ejvs.2009.09.027"},{"key":"ref36","doi-asserted-by":"crossref","unstructured":"Dembowski E, Freedman I, Grundy SM, Stone NJ. Guidelines for the management of hyperlipidemia: how can clinicians effectively implement them? Prog Cardiovasc Dis 2022;75:4\u201311. https:\/\/doi.org\/10.1016\/j.pcad.2022.11.009; PMID:\u00a036395880.","DOI":"10.1016\/j.pcad.2022.11.009"},{"key":"ref37","doi-asserted-by":"crossref","unstructured":"Tokgozoglu L, Bruckert E. Implementation, target population, compliance and barriers to risk guided therapy. Eur J Prev Cardiol 2012;19(Suppl):37\u201341. https:\/\/doi.org\/10.1177\/2047487312448989; PMID:\u00a022801069.","DOI":"10.1177\/2047487312448989"},{"key":"ref38","doi-asserted-by":"crossref","unstructured":"Dixon DL, Sharma G, Sandesara PB, et al. Therapeutic inertia in cardiovascular disease prevention: time to move the bar. J Am Coll Cardiol 2019;74:1728\u201331. https:\/\/doi.org\/10.1016\/j.jacc.2019.08.014; PMID:\u00a031558257.","DOI":"10.1016\/j.jacc.2019.08.014"},{"key":"ref39","doi-asserted-by":"crossref","unstructured":"Unverzagt S, Oemler M, Braun K, Klement A. Strategies for guideline implementation in primary care focusing on patients with cardiovascular disease: a systematic review. Fam Pract 2014;31:247\u201366. https:\/\/doi.org\/10.1093\/fampra\/cmt080; PMID:\u00a024367069.","DOI":"10.1093\/fampra\/cmt080"},{"key":"ref40","doi-asserted-by":"crossref","unstructured":"Eagle KA, Koelling TM, Montoye CK. Primer: implementation of guideline-based programs for coronary care. Nat Clin Pract Cardiovasc Med 2006;3:163\u201371. https:\/\/doi.org\/10.1038\/ncpcardio0499; PMID:\u00a016505862.","DOI":"10.1038\/ncpcardio0499"},{"key":"ref41","doi-asserted-by":"crossref","unstructured":"Glasgow RE, Harden SM, Gaglio B, et al. 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J Card Fail 2022;28:1245\u201354. https:\/\/doi.org\/10.1016\/j.cardfail.2022.03.349; PMID:\u00a035460884.","DOI":"10.1016\/j.cardfail.2022.03.349"},{"key":"ref56","doi-asserted-by":"crossref","unstructured":"B\u00f6hm M, Drexler H, Oswald H, et al. Fluid status telemedicine alerts for heart failure: a randomized controlled trial. Eur Heart J 2016;37:3154\u201363. https:\/\/doi.org\/10.1093\/eurheartj\/ehw099; PMID:\u00a026984864.","DOI":"10.1093\/eurheartj\/ehw099"},{"key":"ref57","doi-asserted-by":"crossref","unstructured":"Abraham WT, Adamson PB, Bourge RC, et al. Wireless pulmonary artery haemodynamic monitoring in chronic heart failure: a randomised controlled trial. Lancet 2011;377:658\u201366. https:\/\/doi.org\/10.1016\/S0140-6736(11)60101-3; PMID:\u00a021315441.","DOI":"10.1016\/S0140-6736(11)60101-3"},{"key":"ref58","doi-asserted-by":"crossref","unstructured":"Bourge RC, Abraham WT, Adamson PB, et al. Randomized controlled trial of an implantable continuous hemodynamic monitor in patients with advanced heart failure: the COMPASS-HF study. J Am Coll Cardiol 2008;51:1073\u20139. https:\/\/doi.org\/10.1016\/j.jacc.2007.10.061; PMID:\u00a018342224.","DOI":"10.1016\/j.jacc.2007.10.061"},{"key":"ref59","doi-asserted-by":"crossref","unstructured":"Ritzema J, Troughton R, Melton I, et al. Physician-directed patient self-management of left atrial pressure in advanced chronic heart failure. Circulation 2010;121:1086\u201395. https:\/\/doi.org\/10.1161\/CIRCULATIONAHA.108.800490; PMID:\u00a020176990.","DOI":"10.1161\/CIRCULATIONAHA.108.800490"},{"key":"ref60","doi-asserted-by":"crossref","unstructured":"Adamson PB, Gold MR, Bennett T, et al. Continuous hemodynamic monitoring in patients with mild to moderate heart failure: results of the Reducing Decompensation Events Utilizing Intracardiac Pressures in Patients with Chronic Heart Failure (REDUCEhf) trial. 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Haemodynamic-guided management of heart failure (GUIDE-HF): a randomised controlled trial. Lancet 2021;398:991\u20131001. https:\/\/doi.org\/10.1016\/S0140-6736(21)01754-2; PMID:\u00a034461042.","DOI":"10.1016\/S0140-6736(21)01754-2"},{"key":"ref64","doi-asserted-by":"crossref","unstructured":"Sharif F, Rosenkranz S, Bartunek J, et al. Safety and efficacy of a wireless pulmonary artery pressure sensor: primary endpoint results of the SIRONA 2 clinical trial. ESC Heart Fail 2022;9:2862\u201372. https:\/\/doi.org\/10.1002\/ehf2.14006; PMID:\u00a035686479.","DOI":"10.1002\/ehf2.14006"},{"key":"ref65","unstructured":"Brugts JJ, Radhoe SP, Clephas PRD, et al. Remote haemodynamic monitoring of pulmonary artery pressures in patients with chronic heart failure (MONITOR-HF): a randomised clinical trial. Lancet 2023;401:2113\u201323. https:\/\/doi.org\/10.1016\/S0140-6736(23)00923-6; PMID:\u00a037220768."},{"key":"ref66","unstructured":"D\u2019Amario D, Meerkin D, Restivo A, et al. Safety, usability, and performance of a wireless left atrial pressure monitoring system in patients with heart failure: the VECTOR-HF trial. Eur J Heart Fail 2023;25:902\u201311. https:\/\/doi.org\/10.1002\/ejhf.2869; PMID:\u00a037092287."},{"key":"ref67","doi-asserted-by":"crossref","unstructured":"Guichard JL, Bonno EL, Nassif ME, et al. Seated pulmonary artery pressure monitoring in patients with heart failure: results of the PROACTIVE-HF trial. JACC Heart Fail 2024;12:1879\u201393. https:\/\/doi.org\/10.1016\/j.jchf.2024.05.017; PMID:\u00a039152983.","DOI":"10.1016\/j.jchf.2024.05.017"},{"key":"ref68","doi-asserted-by":"crossref","unstructured":"Varma N, Epstein AE, Irimpen A, et al. Efficacy and safety of automatic remote monitoring for implantable cardioverter-defibrillator follow-up: the Lumos-T Safely Reduces Routine Office Device Follow-up (TRUST) trial. Circulation 2010;122:325\u201332. https:\/\/doi.org\/10.1161\/CIRCULATIONAHA.110.937409; PMID:\u00a020625110.","DOI":"10.1161\/CIRCULATIONAHA.110.937409"},{"key":"ref69","doi-asserted-by":"crossref","unstructured":"Gu\u00e9don-Moreau L, Lacroix D, Sadoul N, et al. A randomized study of remote follow-up of implantable cardioverter defibrillators: safety and efficacy report of the ECOST trial. Eur Heart J 2013;34:605\u201314. https:\/\/doi.org\/10.1093\/eurheartj\/ehs425; PMID:\u00a023242192.","DOI":"10.1093\/eurheartj\/ehs425"},{"key":"ref70","doi-asserted-by":"crossref","unstructured":"Hindricks G, Taborsky M, Glikson M, et al. Implant-based multiparameter telemonitoring of patients with heart failure (IN-TIME): a randomised controlled trial. Lancet 2014;384:583\u201390. https:\/\/doi.org\/10.1016\/S0140-6736(14)61176-4; PMID:\u00a025131977.","DOI":"10.1016\/S0140-6736(14)61176-4"},{"key":"ref71","doi-asserted-by":"crossref","unstructured":"Sardu C, Santamaria M, Rizzo MR, et al. Telemonitoring in heart failure patients treated by cardiac resynchronisation therapy with defibrillator (CRT-D): the TELECART study. Int J Clin Pract 2016;70:569\u201376. https:\/\/doi.org\/10.1111\/ijcp.12823; PMID:\u00a027291327.","DOI":"10.1111\/ijcp.12823"},{"key":"ref72","doi-asserted-by":"crossref","unstructured":"Morgan JM, Kitt S, Gill J, et al. Remote management of heart failure using implantable electronic devices. Eur Heart J 2017;38:2352\u201360. https:\/\/doi.org\/10.1093\/eurheartj\/ehx227; PMID:\u00a028575235.","DOI":"10.1093\/eurheartj\/ehx227"},{"key":"ref73","doi-asserted-by":"crossref","unstructured":"Tajstra M, Sokal A, Gadula-Gacek E, et al. Remote Supervision to Decrease Hospitalization Rate (RESULT) study in patients with implanted cardioverter-defibrillator. Europace 2020;22:769\u201376. https:\/\/doi.org\/10.1093\/europace\/euaa072; PMID:\u00a032304216.","DOI":"10.1093\/europace\/euaa072"},{"key":"ref74","doi-asserted-by":"crossref","unstructured":"Antonicelli R, Testarmata P, Spazzafumo L, et al. Impact of telemonitoring at home on the management of elderly patients with congestive heart failure. J Telemed Telecare 2008;14:300\u20135. https:\/\/doi.org\/10.1258\/jtt.2008.071213; PMID:\u00a018776075.","DOI":"10.1258\/jtt.2008.071213"},{"key":"ref75","doi-asserted-by":"crossref","unstructured":"Dendale P, De Keulenaer G, Troisfontaines P, et al. Effect of a telemonitoring-facilitated collaboration between general practitioner and heart failure clinic on mortality and rehospitalization rates in severe heart failure: the TEMA-HF 1 (TElemonitoring in the MAnagement of Heart Failure) study. Eur J Heart Fail 2012;14:333\u201340. https:\/\/doi.org\/10.1093\/eurjhf\/hfr144; PMID:\u00a022045925.","DOI":"10.1093\/eurjhf\/hfr144"},{"key":"ref76","doi-asserted-by":"crossref","unstructured":"Koehler F, Koehler K, Deckwart O, et al. Efficacy of telemedical interventional management in patients with heart failure (TIM-HF2): a randomised, controlled, parallel-group, unmasked trial. Lancet 2018;392:1047\u201357. https:\/\/doi.org\/10.1016\/S0140-6736(18)31880-4; PMID:\u00a030153985.","DOI":"10.1016\/S0140-6736(18)31880-4"},{"key":"ref77","doi-asserted-by":"crossref","unstructured":"Artanian V, Rac VE, Ross HJ, Seto E. Impact of remote titration combined with telemonitoring on the optimization of guideline-directed medical therapy for patients with heart failure: protocol for a randomized controlled trial. JMIR Res Protoc 2020;9:e19705. https:\/\/doi.org\/10.2196\/19705; PMID:\u00a033048057.","DOI":"10.2196\/19705"},{"key":"ref78","doi-asserted-by":"crossref","unstructured":"Romero E, Yala S, Sellers-Porter C, et al. Remote monitoring titration clinic to implement guideline-directed therapy for heart failure patients with reduced ejection fraction: a pilot quality-improvement intervention. Front Cardiovasc Med 2023;10:1202615. https:\/\/doi.org\/10.3389\/fcvm.2023.1202615; PMID:\u00a037404735.","DOI":"10.3389\/fcvm.2023.1202615"},{"key":"ref79","unstructured":"Vrints C, Andreotti F, Koskinas KC, et al. 2024 ESC guidelines for the management of chronic coronary syndromes. Eur Heart J 2024;45:3415\u2013537. https:\/\/doi.org\/10.1093\/eurheartj\/ehae177; PMID:\u00a039210710."},{"key":"ref80","doi-asserted-by":"crossref","unstructured":"Ansari S, Nadar BG, Est\u00eav\u00e3o MD, et al. 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