Impact of Digital Remote Monitoring on the Optimization of Guideline-Directed Medical Therapy Titration in Heart...

Aim    To evaluate the impact of digital remote monitoring on the effectiveness of intensive dose titration for guideline-directed medical therapy (GDMT) in patients with heart failure with reduced ejection fraction (HFrEF) for the achievement of target doses and the reduction of decompensated heart failure rate and all-cause mortality.Materials and methods    The study utilized vital sign monitoring via a personal messenger-based questionnaire (chatbot) and weekly therapy optimization recommendations for 6 weeks following hospital discharge. The control group received standard outpatient care. The study is registered at ClinicalTrials.gov (NCT06304753). Between October 27, 2023, and December 27, 2024, 66 HFrEF patients were enrolled and randomized into a remote monitoring (RM) group (n=33) and a standard care (SC) group (n=33). The 6-week observation period was completed by 26 patients in the RM group and all 33 patients in the SC group.Results    The RM group showed a statistically significant increase in the dosages of GDMT and a higher number of patients reaching target doses. In contrast, the SC group showed either no changes in therapy or a decrease in dosages of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers/angiotensin receptor-neprilysin inhibitor (87.5 [50; 100]% vs. 25 [12.5; 25]%, p<0.001); beta-blockers (100 [50; 100]% vs. 50 [25; 50]%, p<0.001); and mineralocorticoid receptor antagonists (100 [100; 100]% vs. 50 [50; 100]%, p=0.005). Diuretic doses were reduced in the RM group (2 adjusted doses (AD) [1; 2] at baseline vs. 1 AD [0.5; 2] at 6 weeks; p=0.010) but remained unchanged in the SC group (2 [2; 2] AD at baseline vs. 2 [2; 2] AD at 6 weeks; p=0.9). The incidence of decompensated CHF and death was significantly higher in the SC group compared to the RM group, 16 cases (2 deaths, 14 decompensations) vs. 2 cases (0 deaths, 2 decompensations; p<0.001). Intensive titration proved safe, with no statistically significant differences observed between groups at 6 weeks regarding systolic blood pressure (119 [110-130] mm Hg vs. 120 [110-130] mm Hg; p=0.9), heart rate (70.5 [62-80] bpm vs. 78 [73-91.5] bpm; p=0.062), glomerular filtration rate (65.9 [49.2-77] mL/min/1.73 m² vs. 49.6 [45.8-71.9] mL/min/1.73 m²; p=0.22), or serum potassium levels (4.39 ± 0.48 mmol/L vs. 4.218 ± 0.37 mmol/L; p=0.33).Conclusion    The study confirmed the feasibility, efficacy, and safety of intensive titration of guideline-directed medical therapy for chronic heart failure using remote monitoring.