Techniques of inducing a physiological perturbation to monitor a heart failure status of a patient are described. An implantable medical device (IMD) may induce a physiological perturbation in the patient to monitor and determine how the patient responds to the physiological change. This response may be indicative of heart failure improvement or worsening. For example, the IMD may deliver electrical stimulation with parameters configured to perturb the patient (e.g., stimulation that deviates from stimulation therapy). The IMD may then detect at least one physiological parameter to monitor the patient's response to the perturbation. Based on the detected physiological parameter, the IMD may generate a heart failure status. The heart failure status may then be used for adjusting patient therapy, with or without the use of remote monitoring.