Background The Better Effectiveness After Transition – Heart Failure (BEAT-HF) study is a comparative effectiveness randomized control trial that evaluated 180-day remote patient monitoring among recently hospitalized older heart failure patients. Adherence played a key role in its findings, and we sought to identify potential underlying barriers to telemedicine adherence. Methods Data were collected from phone logs documenting patient interaction during device issue management. Two researchers coded the records separately using a compiled code list and convened regularly to reconcile discrepancies. Descriptive analyses were conducted on reported device issues. Results Of 715 intervention patients, 314 (43.9%) reported issues with participating in the intervention. 183 (25.6%) reported device issues, and 247 (34.5%) reported non-device issues; 116 (16.2%) reported both device and non-device issues. The most prevalent device issues among patients were transmission difficulties (n=122), either connecting the cellular transmission device from the home to the call center (n=72), or transmitting biometric readings to the cellular transmission device (n=53). The most prevalent non-device issues per patient were battery replacement (n=80), hospitalization (n=51), and illness or disability (n=50). The maximum number of distinct coded issues for an individual patient was both 8 for device and non-device issues. Conclusion Introducing technology to aging populations can encounter device issues that affect participation. We found more technological than health issues, thus future monitoring programs should consider connectivity issues and shorter monitoring periods given battery issues. Further research is needed to correlate user difficulty and device issues with patient adherence.