OBJECTIVES: Heart failure patients with implantable defibrillators (ICD) frequently undergo in office visits, placing a great burden on healthcare providers. Internet-based remote device interrogation systems are being proposed in order to reduce these visits, as well as to promptly detect and notify alert conditions METHODS: EVOLVO was a prospective, randomized, parallelmulticenter clinical trial comparing remote ICD management with the current standard of care, assessing their effectiveness and costs.Primary end-point: rate of cardiac or device related unplanned emergency department (ED) or urgent in-office visits. Secondary end-point: all healthcare utilizations for HF, arrhythmias or device related events; quality of life (QoL), assessed with the Minnesota Living with Hearth Failure Questionnaire (MLHFQ), and EuroQol five Dimensions (EQ 5D). Costs were considered from National Health Services (NHS) and patients’ and society point of view RESULTS: Two hundred patients (79% males; 66±10years) implanted with ICD (92% biventricular ICD) were enrolled in five Hospitals in Italy, with a follow-up of 16 months.The rate of visits considered in primary endpoint was reduced by 36% in remote arm (75 versus 117; Incidence density: 0.59 versus 0.93 events/year; p=0.005).  Overall, there were 1285 healthcare utilizations (secondary endpoint) with a difference of 23% in the rates of events (4.40 events/year in remote arm vs 5.74 events/year in standard arm).The telemonitoring implied annual cost saving per patient-year for NHS: €1962.78 for remote arm versus €2130.01 for the standard arm. Further, remote arm gained 0.065 QALYs per patient vs standard arm. From patients and society point of view, a cumulative costs per patient-year of 154 € (standard arm) versus 112 € (remote arm) was assessed CONCLUSIONS: Remote management of chronic heart failure patients with ICD is a cost-effective solution, with clinical and economic benefits for both health care systems and patients. A large-scale adoption should be supported