AIMS: Digital health solutions targeted to remote clinical monitoring are constantly gaining ground in cardiovascular care. However, evidence regarding their impact on cardiac rehabilitation efficiency in heart failure (HF) patients is relatively limited. In this study, conducted in the context of the IntellIoT project, we evaluated the effect of a purpose-designed Internet of Things (IoT)-based patient monitoring system on cardiac rehabilitation outcomes in a cohort of HF patients. METHODS AND RESULTS: Nineteen clinically stable HF patients were enrolled in the study, which consisted of a 12-month standard-of-care run-in phase and a remote follow-up phase of equal duration, whereby an IoT-based e-health system was provided to study subjects. Device-derived data transmission was facilitated by a mobile phone application, coupled with a web-based platform accessible to study physicians. Study endpoints were (i) patient adherence rates to e-health system use and their associations to key clinical parameters, (ii) the degree of change in physical activity, and (iii) total time dedicated by physicians to enrolled patients' care with and without the aid of the e-health system. Baseline-to-peak increase in daily step count was calculated at 23.34%. System use was associated with a decrease in time dedicated by physicians to enrolled patients' care. A significant negative correlation was observed between age and progressive drop-in adherence rate to system use ( CONCLUSION: Internet of Things-based healthcare constitutes a promising approach in HF patients' rehabilitation, whereas elderly patients might constitute the population most likely to benefit. However, larger, randomized studies are required to confirm our findings.