Maren spent most of last winter going into the hospital and coming back out of it. Twice in eleven weeks, her heart failure tipped over into fluid on her lungs, and twice she ended up in the emergency department at two in the morning, breathless and frightened, with her daughter driving.

She is 61, a retired school librarian, and she lives alone in a small house above the harbor in Duluth with a view she will tell you about whether you ask or not. She was diagnosed with heart failure four years ago. For three of those years it was something she managed. Last winter it started managing her.

The gap between appointments

"Every time I went in, they'd say it had probably been building for a week," Maren says. "And I'd think, well, I was fine a week ago. I was fine on Tuesday."

That is the problem the heart failure team at Great Lakes Health had been trying to solve for years. Fluid builds slowly. The early signs are small: a resting breathing rate that creeps up by two or three breaths a minute, a heart rate that does not settle at night the way it used to, a little less time spent walking around. None of them are things a person notices in themselves. All of them show up days before the breathlessness does.

"By the time someone calls us saying they can't lie flat, we're already in rescue mode," says Jolene Petrakis, the heart failure nurse who has looked after Maren since her diagnosis. "The whole game is seeing it earlier. And you can't see it earlier from a clinic appointment every three months."

Six weeks with a patch

After her second admission, Maren went home with an Axon Sense patch on her upper arm and a small hub on the table next to her reading chair. The patch records her heart rhythm, her breathing, her skin temperature and how much she moves, around the clock. The hub sends it on to the clinic. Every week she swaps the adhesive carrier, which takes about a minute. Every nine days the patch goes on the charger overnight.

"I was expecting something with a screen that beeped at me," she says. "It doesn't do anything. It just sits there. My granddaughter asked what it was for and I had to think about it."

That was deliberate. Maren does not have a smartphone she trusts, and the program at Great Lakes was designed so that she would not need one. The hub has its own cellular connection. It was paired to her patch before it left the depot. Setup was plugging it into the wall.

I saw her breathing change on a Thursday. She felt it the following Sunday. Those three days are the whole program.

Jolene Petrakis, RN, heart failure nurse, Great Lakes Health

The Thursday

In the fourth week, Maren's resting breathing rate went up. Not by much: from around 16 breaths a minute at night to around 19, over three nights. Her nighttime heart rate went up with it. Her daily activity dropped by about a fifth.

The program flagged it on Thursday morning. Jolene called Maren that afternoon. Maren said she felt fine, maybe a little tired. Jolene asked about her weight, her ankles, and how many pillows she had slept on. Then she talked to Maren's cardiologist, and Maren's diuretic dose went up that evening.

On Sunday, Maren noticed she was a bit short of breath on the stairs. By Wednesday she wasn't. She did not go to the hospital.

Maren's six weeks

Monitoring period
42 days
Wear time
97 percent of hours
Alerts reviewed by the clinic
3
Medication changes
1, by phone
Hospital admissions
None
Clinic visits
1, scheduled

What did not change

It would be easy to tell this story as if a device fixed something. It did not. Maren's heart is the same heart. The medicines are the same medicines. The nurse is the same nurse, and the phone call she made was the same phone call she would have made if Maren had walked into clinic that Thursday with the same numbers.

What changed is that Jolene had the numbers on Thursday instead of on the next admission. The program's job was to move one conversation three days earlier. That turned out to be enough.

"People ask me if I mind being watched," Maren says. "I don't feel watched. I feel like somebody has the night shift."

Where she is now

Maren finished her six weeks in the spring and the patch came off. She has had one more short monitoring period since, after a medication change, and no admissions this year. She walks the lakewalk most mornings when it is not icy, and some mornings when it is.

The Great Lakes Health heart failure program now runs Axon Sense monitoring for every patient discharged after a heart failure admission, for the first six weeks at home. Readmissions in that group are being tracked against the year before, and the team expects to publish the results in 2027.

Nexaform Labs is a fictional company. The people, places and figures in this story are invented for demonstration.