Patient nonadherence to medical care programs, and in this case home telehealth, may be associated with negative patient outcomes. The extent to which nonadherence is a prevailing problem and its link with poor outcomes has not been fully researched. This is a retrospective study using secondary data to look at early adherence to the use of a home telehealth device called the Healthy Buddy® by older veterans with heart failure enrolled in the Department of Veterans Affairs (VA), Office of Care Coordination, Care Coordination/Home Telehealth (CCHT) Program in the Southern California and Nevada regions between 6/1/06 and 6/1/08. The purposes of the study are to describe patient adherence to the use of Healthy Buddy®, to determine potential predictors of adherence, and to determine the associations between adherence and clinical outcomes and healthcare utilization in the first 90 days after enrollment. Findings include: high early nonadherence rates; significant differences in adherence when assessed during different time frames; significant differences in adherence based on VA station or where the CCHT program is embedded in (e.g., primary care versus geriatrics or home health program); a weak negative relationship between comorbidity and adherence in the first 30 days after enrollment; and lack of relationship between outcome variables and adherence in the first 90 days after enrollment. Implications for practice and future research are suggested.