Leveraging Remote Patient Monitoring to Effectively Put the Heart Failure Guidelines to Practice

Guideline directed medical therapy (GDMT) effectively reduces morbidity and mortality for patients with heart failure (HF) [ 1 Heidenreich PA Bozkurt B Aguilar D Allen LA Byun JJ Colvin MM Deswal A Drazner MH Dunlay SM Evers LR Fang JC Fedson SE Fonarow GC Hayek SS Hernandez AF Khazanie P Kittleson MM Lee CS Link MS Milano CA Nnacheta LC Sandhu AT Stevenson LW Vardeny O Vest AR Yancy CW. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2022 May 3; 79: e263-e421https://doi.org/10.1016/j.jacc.2021.12.012 Crossref PubMed Scopus (816) Google Scholar ]. Unfortunately, despite clear recommendations for initiating and titrating GDMT [ 2 Sharma A Verma S Bhatt DL Connelly KA Swiggum E Vaduganathan M Zieroth S Butler J. Optimizing Foundational Therapies in Patients With HFrEF: How Do We Translate These Findings Into Clinical Care?. JACC Basic Transl Sci. 2022 Mar 2; 7: 504-517https://doi.org/10.1016/j.jacbts.2021.10.018 Crossref PubMed Scopus (48) Google Scholar ], optimization of GDMT in HF patients nationwide is staggeringly low [ 3 Savarese G Kishi T Vardeny O Adamsson Eryd S Bodegård J Lund LH Thuresson M Bozkurt B Heart Failure Drug Treatment-Inertia, Titration, and Discontinuation: A Multinational Observational Study (EVOLUTION HF). JACC Heart Fail. 2023 Jan; 11 (Epub 2022 Sep 7. PMID:36202739): 1-14https://doi.org/10.1016/j.jchf.2022.08.009 Crossref PubMed Scopus (66) Google Scholar ]. Reasons such as clinical inertia, inaccessibility of clinicians, and patient level cost and medical constraints are often to blame [ 4 Girerd N Von Hunolstein JJ Pellicori P Bayés-Genís A Jaarsma T Lund LH Bilbault P Boivin JM Chouihed T Costa J Eicher JC Fall E Kenizou D Maillier B Nazeyrollas P Roul G Zannad N Rossignol P Seronde MF Group EF-HF Therapeutic inertia in the pharmacological management of heart failure with reduced ejection fraction. ESC Heart Fail. 2022 Aug; 9: 2063-2069https://doi.org/10.1002/ehf2.13929 Crossref PubMed Scopus (17) Google Scholar ]. Remote patient monitoring (RPM) has helped address these challenges and resulted in improved care for HF patients [ 5 Desai AS Maclean T Blood AJ Bosque-Hamilton J Dunning J Fischer C Fera L Smith KV Wagholikar K Zelle D Gaziano T Plutzky J Scirica B MacRae CA. Remote Optimization of Guideline-Directed Medical Therapy in Patients With Heart Failure With Reduced Ejection Fraction. JAMA Cardiol. 2020 Dec 1; 5: 1430-1434https://doi.org/10.1001/jamacardio.2020.3757 Crossref PubMed Scopus (60) Google Scholar ]. Further adoption of comprehensive RPM and centralized medication titration by health systems is required to close care gaps, improve outcomes, and reduce cost. Outsourcing the GDMT titration efforts to a centralized RPM program could be one of the most impactful solutions.