Information and communications technologies (ICT) currently constitute a key element in the
innovation and improvement of providing health-care to frail populations with advanced
chronic diseases, but it´s efficacy, safety and cost-effectiveness has not yet been proven
conclusively. The investigators are going to carry out a multi-center, randomized, parallel
groups, phase III clinical trial in adult patient with heart and/or lung advanced
diseases,aiming to analyze the efficacy and cost-efficacy of tele-monitorization of
bio-parameters added to optimal standard of clinical care (shared clinical care plan)
compared to the shared clinical care plan exclusively.