Related Experiment Video
Updated: Jul 7, 2025
E-Patient Counseling Trial E-PACO: Computer Based Education versus Nurse Counseling for Patients to Prepare for Colonoscopy
Published on: August 1, 2019
Digital consults to optimize guideline-directed therapy: design of a pragmatic multicenter randomized controlled
Jelle P Man1,2,3,4, Marcel G W Dijkgraaf5,6, M Louis Handoko2,4
1Department of Cardiology, Amsterdam UMC location AMC, Amsterdam, The Netherlands.
Insights
Digital consults can improve guideline-directed medical therapy (GDMT) for heart failure (HF) patients. The ADMINISTER trial shows DCs enhance GDMT optimization and patient care efficiency.
Area of Science:
- Cardiology
- Digital Health
- Health Services Research
Background:
- Guideline-directed medical therapy (GDMT) is crucial for heart failure (HF) management but often underutilized.
- Digital consults (DCs) offer a promising avenue to improve GDMT optimization efficiency for the growing HF population.
Purpose of the Study:
- To evaluate the efficacy and safety of digital consults (DCs) for optimizing guideline-directed medical therapy (GDMT) in heart failure (HF) patients.
- To assess the impact of multifaceted digital consults on GDMT prescription rates, optimization time, patient/clinician satisfaction, and healthcare utilization.
Main Methods:
- Pragmatic, multicenter, randomized controlled open-label trial (ADMINISTER trial) involving 150 HF with reduced ejection fraction patients.
- Intervention group received multifaceted DCs: digital data sharing, e-learning patient education, and digital guideline recommendations.
- Comparison group received standard care; primary outcome was GDMT prescription rate score.
Main Results:
- The ADMINISTER trial will provide the first randomized controlled data on GDMT optimization using digital consults.
- Key outcomes include GDMT prescription rates, time to full optimization, patient/clinician satisfaction, healthcare time, and quality of life.
Conclusions:
- Digital consults represent a novel and effective strategy for enhancing guideline-directed medical therapy in heart failure.
- The ADMINISTER trial findings will inform the integration of digital health solutions into routine HF care pathways.
Aims:
Many heart failure (HF) patients do not receive optimal guideline-directed medical therapy (GDMT) despite clear benefit on morbidity and mortality outcomes. Digital consults (DCs) have the potential to improve efficiency on GDMT optimization to serve the growing HF population. The investigator-initiated ADMINISTER trial was designed as a pragmatic multicenter randomized controlled open-label trial to evaluate efficacy and safety of DC in patients on HF treatment.
Methods And Results:
Patients (n = 150) diagnosed with HF with a reduced ejection fraction will be randomized to DC or standard care (1:1). The intervention group receives multifaceted DCs including (i) digital data sharing (e.g. exchange of pharmacotherapy use and home-measured vital signs), (ii) patient education via an e-learning, and (iii) digital guideline recommendations to treating clinicians. The consults are performed remotely unless there is an indication to perform the consult physically. The primary outcome is the GDMT prescription rate score, and secondary outcomes include time till full GDMT optimization, patient and clinician satisfaction, time spent on healthcare, and Kansas City Cardiomyopathy Questionnaire. Results will be reported in accordance to the CONSORT statement.
Conclusions:
The ADMINISTER trial will offer the first randomized controlled data on GDMT prescription rates, time till full GDMT optimization, time spent on healthcare, quality of life, and patient and clinician satisfaction of the multifaceted patient- and clinician-targeted DC for GDMT optimization.
Related Concept Videos
01:16Clinical Trials
There are four phases in a clinical trial. A phase one...
01:11Blinding
01:12Hazard Ratio
For example, in a clinical trial...