BACKGROUND: Wearable cardioverter-defibrillators (WCDs) are equipped with the TRENDS remote-monitoring system, enabling continuous assessment of arrhythmias, physiological parameters, and patient-reported outcomes. This study evaluated the clinical utility of TRENDS-integrated WCD management and compared it with a historical control. METHODS: We prospectively analyzed 36 consecutive patients who received a WCD with TRENDS between 2019 and 2024 and compared them with 30 historical controls treated before the implementation of TRENDS. RESULTS: The WCD indications were heart failure as primary prevention (64%) and acute coronary syndrome with ventricular arrhythmias (28%). Among 18 patients who met the criteria for an implantable cardioverter-defibrillator (ICD), including 1 patient with WCD shock, 9 ultimately underwent ICD implantation. The mean daily WCD wear-time was 21.3 h and did not differ significantly from that of the historical control. The response rate to health-related questionnaires was 89%. TRENDS detected symptom exacerbation in 31% of patients, weight gain in 19% of patients, and missed medication in 19% of patients. Daily step-count was significantly lower in patients with ICD indications than in those without (5012 ± 2980 steps vs. 7977 ± 3584 steps, p = 0.01). TRENDS data also aided in initiating anticoagulation therapy and optimizing beta-blocker therapy. CONCLUSIONS: TRENDS provided clinically actionable physiologic and patient-reported information that supported individualized cardiovascular management.