Telemonitored standardized titration for heart failure with reduced ejection fraction, an open clinical cohort study

To evaluate feasibility, efficacy, and safety of standardized medical titration at home using telemonitoring. Treatment for heart failure with reduced ejection fraction (HFrEF) has advanced rapidly, emphasizing swift initiation and titration of guideline-directed medical therapy (GDMT) to improve outcomes. Implementing this in practice remains a significant challenge for healthcare. This study proposes a standardized home-based titration process incorporating home-based monitoring (HBM) to enhance GDMT titration, reduce delays, and limit the need for in-clinic assessment visits.

60 patients were enrolled in this open cohort study. Standardized pre-specified titration schedules in combination with HBM were evaluated. Outcome measures included the time to optimal medical therapy (OMT), doses of GDMT at 8 weeks and 6 months, and safety evaluation through adverse events. The median time to OMT was 48 days (IQR 42-60). All participants achieved OMT within 6 months. At 8 weeks, 73%, 85%, and 88% had reached target doses for beta-blockers, ACE inhibitors, and mineral receptor antagonists, respectively. All participants reached SGLT2i target dosage. By 6 months, 62%, 73%, 80%, and 97% were on target doses for these medications, and 43% had achieved target doses for all four GDMT drugs. No serious adverse events occurred during titration.

We present a novel and promising approach for achieving OMT and high GDMT doses in patients with HFrEF. The utilization of standardized protocols has the potential to optimize the titration process of GDMT, and with HBM support, it can be accomplished with few in-clinic visits.