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

Figures

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  Figure 1. Study overview. Summary of the workflow for home-based monitoring, standardized medical titration, and blood sampling in the TELEFASTER-HF study. Guideline-directed medical therapy (GDMT) titration followed standardized protocols, adjusted to individual regimens, advancing to target doses, or modified for side effects. GP, general practitioner.

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  Figure 2. Time to optimal medical therapy (OMT). Cumulative proportion of patients achieving OMT over time. The median time to reach OMT from inclusion was 48 days (IQR 42–60 days). IQR, inter-quartile range.

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  Figure 3. Titration of guideline-directed medical therapy (GDMT). Doses of beta-blockers (A), RASi (B), MRA (C), and SGLT2i (D) at inclusion, at 8 weeks, and 6 months. By 8 weeks, 73% of participants reached beta-blocker (BB) target doses, decreasing to 62% at 6 months, with 5% off BB therapy. For RASi, 85% achieved target doses by 8 weeks, decreasing to 73% at 6 months, with 2% off therapy. MRA target doses were reached by 88% at 8 weeks and 80% at 6 months, while 5% were off therapy. SGLT2i therapy increased from 70% at inclusion to 100% at 8 weeks, with 97% remaining on therapy at 6 months.

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  Figure 4. Changes in ejection fraction, NT-proBNP, weight, and blood pressure following optimal medical therapy (OMT). Comparison of ejection fraction (EF) at diagnosis and after achieved OMT (A), and NT-proBNP levels (B), weight (C), and systolic blood pressure (D) measured at inclusion and at 6 months, by which time all patients had achieved OMT. After OMT, follow-up echocardiography showed improved LVEF (median 46.5% vs. 30%, P < 0.001) compared with LVEF at diagnosis. NT-proBNP levels significantly decreased from 1355 to 396 pg/mL (P < 0.001), along with reductions in body weight (from 84.8 to 80.5 kg, P < 0.001) and systolic blood pressure (from 123 to 116 mmHg, P < 0.001).