Heart failure (HF) is a growing global public health concern. Worldwide, the estimated prevalence of HF has increased to >64.3 million cases. Despite improvement in outcomes with medication, HF is a leading cause of hospitalization among individuals >65 years. Approximately 30-40% of HF patients have a history of hospitalization, and 50% are re- admitted with 1 year within their initial diagnosis of HF . In Tunisia, the current statistics (2017) show that the all-cause 1-year mortality rate among acute HF patient was 22.8%, the 1-year rate of hospitalization because of HF was 7.3%, and the 1-year incidence rates of the combined event (all-cause mortality or HF hospitalization) was 18.7%. Available literature highlighted that patient monitoring using wearable biosensors is a promising strategy to improve cardiovascular patients care and have potential to support clinical practice and improve patient outcomes .

The objective of this protocol is to evaluate the feasibility and effectiveness of continuous tele- ECG monitoring in predicting hospital readmission and other clinical relevant outcome in patients with AF discharged from the emergency department (ED) after HF decompensation using a novel device "VIVALINK ECG Patch".

Inclusion Criteria: (1) Patients having an HF decompensation diagnosis, patients with reduced ejection fraction<50%, (2) having a documented AF (3) have a plan for discharging with partnering home health services, (4) agree to use the wearable ECG patch for 30 days (5) with a permanent residential address (6) without significant cognitive impairment and (7) understand English language.

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Exclusion Criteria: (1) patients having implanted pacemaker or any electrical devices; (2) having an allergy to hydrocolloid gel adhesive or skin diseases; (3) unstable vital signs, (4) being on dialysis; (5) having a documented visual, cognitive, or physical impairment that would interfere with the ability to comply with the study procedures, (6) pregnant women (7) having inability to give an informed consent.

All patients with HF decompensation who will be discharged from the emergency department of Fattouma Bourguiba University Hospital (Monastir, Tunisia) and emergency department of Sahloul University Hospital following HF decompensation.