In recent years, heart disease has been a major widespread public health problem in most countries [1]. According to Centers for Disease Control and Prevention reports heart failure is the primary cause of more than 55,000 deaths each year. One out of nine deaths in 2008 was due to heart failure. About half the patients who have heart failure die within 5 years of diagnosis [2], and 40% of patients with chronic heart failure (CHF) die after hospital admission or within one year after they are admitted [3]. CHF is costly for healthcare systems in many countries. In the United States, it is estimated that this disease has cost more than $20 billion [4]. The global cost of heart disease is estimated at $863 billion in 2010 and it is estimated to rise to $1,044 billion by 2030 [5]. In spite of pharmacologic advances and mechanical therapies, prevalence of CHF is rising [6]. However, studies have shown that delay in symptom diagnosis, nonconformity with diet and medication instructions, as well as lack of knowledge and skills of patients for self-management are common causes of re-hospitalization of CHF disease [7-9]. Obviously, improving the monitoring of these patients, the use of self-management programs by patients, providing appropriate treatment based on clinical guidelines, educating patients and helping them pursue their care plans lead to improved treatment and prevention of deterioration of the status of these patients, decreasing hospital re-admission and reducing the use of healthcare resources [10-12]. Given the importance of the follow-up of CHF patients to reduce common causes of re-admission and deterioration of their status that lead to imposing spiritual and physical pressures on patients, their families, healthcare centers, and society, modern technology tools should be used to the best advantage. Use of information technology tools would be helpful to improve the monitoring of patients through continuous assessment of symptoms and signs of disease and checking compliance with self-management programs, thus, improving treatment, and resource use [13]. One innovation in the field of information technology in healthcare is the application of artificial intelligence and intelligent systems to facilitate, accelerate, and improve health services, especially in home care and telemedicine. Agents are one of the strongest artificial intelligence areas, especially in the generation of practical solutions for real problems. An agent is a computer system situated in a dynamic and unpredictable environment that is capable of flexible autonomous action to meet its design objectives [14]. One characteristic of agents is mobility, which is suitable for telemedicine and e-Health systems [15]. Multi-agent systems (MASs) are computational systems in which a collection of loosely coupled autonomous agents interact in order to solve a given problem [14]. Surveys have demonstrated the benefits of using multi-agent technologies in healthcare systems. Agents can provide suitable infrastructure for follow-up data analysis and CHF management due to their many advantage, such as autonomy, proactiveness and social ability as well as their ability to manage information located in different places and to handle communication and cooperation between independent elements [16-19]. The aim of this article is to explain key points which should be considered in designing appropriate MAS to improve CHF management. In this literature review articles were searched with keywords like multi-agent system, heart failure, chronic disease management in Science Direct, Google Scholar and PubMed databases without regard to the year of publications.

Chronic diseases like CHF leads to reduced productivity and increased healthcare costs. The prevalence of CHF is rising. Educating patients and helping them to use self-management programs can decrease hospital re-admission. The use of modern ICT tools is the best way to prevent CHF and thus provide, appropriate healthcare management, and increase people empowerment. The architecture of agent-based systems allows high interoperability, and efficient information management, and appropriate sharing data sharing. Clearly, identifying and resolving technical and non-technical challenges are vital to the successful implementation of this technology. Thus, in the design and implementation of agent-based systems many issues should be considered. Information confidentiality and privacy issues and reduced face-to-face communication between patients and doctors can lead to increased stress for in some CHF patients. System must be designed using an appropriate architecture and following communication standards and protocols. The mode of communication between agents, ethical and legal aspects, feedbacks, user attitudes, appropriate readiness, stakeholders supports to use technology, budgeting, motivations, coverage healthcare costs based on MASs by insurance company, hierarchy, cost afford, identification opportunities and barriers, designing and creating a database that is rich in order to provide support of various formats and training and tasks and backup of database.

It should be noted that the use of agent systems only with a technical view is associated with many problems, such as lack of user acceptance. Hence, in delivering healthcare to CHF patients, considering social and human aspects and the involvement of end users and consideration of their needs in all phases of a project is essential. Also, for users, especially elderly people, special attention should be paid to ease of use and user friendliness.