Approximately 20% of patients with acute decompensated heart failure are managed in emergency department observation units. These patients typically do not receive transitional care interventions often available from cardiology services. We explored the transitional needs of this group of patients, with a focus on use of technology. Patients cared for in the emergency department either as an acute visit or an observation unit visit at a single academic medical center were enrolled in the study. Using a grounded theory approach, participants were interviewed using a guide designed to explore previous and current heart failure medical care experiences, self-care (diet, medications, and appointments), psychosocial issues, support in the post-discharge environment, physical activity, and perceived causes and precipitants of any repeat visits. Interviews were transcribed, and coding was done by a group using a constant comparative method. Twenty three patients were interviewed; 15 from the observation unit and 8 who were previously in the ED. Patients were 57 +/- 14 years old, 39% female, 70% Black. Most patients had contacted their physicians prior to coming to the ED, and did not report physician access issues. Patients also felt that they did not need help managing their medications. Patients identified self care domains as their most prominent issues, including difficulty obtaining reliable sources of information regarding heart failure care, maintaining exercise routines, and adhering to dietary rules. Patients had increased difficulty taking care of their heart failure with comorbid conditions. In terms of mobile technology, older patients were resistant to the idea of telehealth as a platform to deliver information, while many younger patients were aware of telehealth and mobile technologies for disease management, but none had used these previously to connect with their physician. Overall, 74% of patients reported having access to a smart phone or computer, while 65%% of patients reported using the internet daily. Patients in observation units for heart failure identified concerns with self care such as nutrition and exercise. Surprisingly, most patients did not report physician access or medication management as significant problems. Although patients report awareness and interest of telehealth, none had used mobile technology in their self care. This study provides data to create a mobile technology-based intervention for patients after an observation stay for acute heart failure.