The clinical utility of remote telemonitoring to reduce post-discharge healthcare utilization and death in adults with heart failure (HF) remains controversial. Within a large integrated health care delivery system, we matched patients enrolled in a post-discharge telemonitoring intervention from 2015-2019 to patients not receiving telemonitoring at up to a 1:4 ratio on age, sex, and calipers of a propensity score. Primary outcomes were readmissions for worsening heart failure (WHF) and all-cause death within 30, 90, and 365 days of index discharge; secondary outcomes were all-cause readmissions and any outpatient diuretic dose adjustments. We matched 726 patients receiving telemonitoring to 1985 controls not receiving telemonitoring, with a mean (SD) age of 75 (11) years and 45% female. Patients receiving telemonitoring did not have a significant reduction in WHF hospitalizations (adjusted rate ratio [aRR]: 0.95, 95% confidence interval [CI]: 0.68, 1.33), all-cause death (adjusted hazard ratio: 0.60, 95% CI: 0.33, 1.08), or all-cause hospitalization (aRR: 0.82, 95% CI: 0.65, 1.05) at 30 days, but did have an increase in outpatient diuretic dose adjustments (aRR: 1.84, 95% CI: 1.44, 2.36). All associations were similar at 90- and 365-days post-discharge. A post-discharge HF telemonitoring intervention was associated with more diuretic dose adjustments but was not significantly associated with HF-related morbidity and mortality.