A pacemaker optimising apparatus comprising: a component (4) which noninvasively or invasively monitors a haemodynamic measurement continuously in an individual and a processor (15) for receiving the haemodynamic measure and generating a pacemaker programming signal in response to this. There is also provided a communication device (17) for sending the pacemaker programming signal to the control system of the pacemaker (2). There is also a method for an efficient process by which this apparatus can automatically use the haemodynamic measurements to determine the ideal settings for a particular pacemaker in a particular individual, and to updates the pacemaker's settings accordingly.