Standardised, telemonitored titration of guideline-directed medical therapy in heart failure is associated with faster optimisation and improved persistence compared to standard of care

Figures

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  Figure 1. Selection of the control cohort. A total of 1093 hospitalisations or outpatient visits with an I50.1a diagnosis were identified at three different hospitals, comprising 396 unique patients. Patients with heart failure (HF) duration >3 months, estimated glomerular filtration rate (eGFR) <45 mL/min/1.73 m² or treatment with beta-blockers (BB) or renin–angiotensin system inhibitors (RASi) at >50% of the target dose at HF diagnosis were excluded. The final control cohort consisted of 65 patients.

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  Figure 2. Time to optimal medical therapy (OMT) from baseline to 12 months, stratified by study group. Time to OMT was substantially shorter in the TELEmonitored FAst Standardized Titration for Efficient Response in Heart Failure with reduced ejection fraction (TELEFASTER-HF) group compared with controls (median 48 vs 321 days; HR 16.1, 95% CI 8.3 to 31.2, p<0.001). By day 90, 93% of TELEFASTER-HF participants had achieved OMT compared with 8% of controls. At 12 months, all TELEFASTER-HF participants had achieved OMT, compared with 54% of controls.

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  Figure 3. Distribution of guideline-directed medical therapy (GDMT) dose categories across the four GDMT drug classes at baseline (index), 8 weeks, 6 months and 12 months. Stacked bar charts show the proportion of patients in the TELEFASTER-HF intervention cohort (n=60) and standard-of-care cohort (n=65) achieving none, 1%–49%, 50%–99% or 100% of guideline-recommended target doses for (A) beta-blockers, (B) renin–angiotensin system inhibitors (RASi), including angiotensin-converting enzyme inhibitors (ACEi), angiotensin receptor blockers (ARB), and angiotensin receptor–neprilysin inhibitors (ARNI), (C) mineralocorticoid receptor antagonists (MRA) and (D) sodium-glucose cotransporter-2 inhibitors (SGLT2i). TELEFASTER-HF, TELEmonitored FAst Standardized Titration for Efficient Response in Heart Failure with reduced ejection fraction.

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  Figure 4. (A) Target dose achievement across all four guideline-directed medical therapy (GDMT) classes. Inverse probability of treatment weighting (IPTW)-weighted proportions of patients achieving 100% target dose in all four GDMT drug classes at index, 8 weeks, 6 months and 12 months in the TELEFASTER-HF cohort and the standard-care cohort. At 8 weeks, TELEFASTER-HF patients were substantially more likely to achieve target doses across all four GDMT classes compared with standard care. ORs with 95% CIs are derived from IPTW-weighted logistic regression models. Comparative inference was prespecified at 8 weeks; analyses at 6 and 12 months are supportive. (B) Implementation of GDMT (any dose) across all four drug classes. IPTW-weighted proportions of patients receiving at least one dose of all GDMT drug classes at index, 8 weeks, 6 months and 12 months in the TELEFASTER-HF cohort and standard-care controls. At 8 weeks, TELEFASTER-HF patients were more likely to receive any dose of all four GDMT classes compared with standard care. ORs with 95% CIs are derived from IPTW-weighted logistic regression models. Comparative inference was prespecified at 8 weeks; analyses at 6 and 12 months are…