Key result
Telemonitoring-guided remote titration increases target GDMT achievement by ~38 percentage points in heart failure.
Why the study?
GDMT remains underutilized in clinical practice, with less than 25% of heart failure patients receiving target doses. Telemonitoring could facilitate remote GDMT titration by providing reliable real-time physiological data.
Does remote titration facilitated by telemonitoring improve the achievement of optimal guideline-directed medical therapy doses in patients with heart failure?
RCT (n=42)
Open-label
Block randomization
No
Does remote titration facilitated by telemonitoring improve the achievement of optimal guideline-directed medical therapy doses in patients with heart failure?
Absolute Event Rate: 86% vs 48%
p-value: p=0.004
Remote titration using smartphone-based telemonitoring significantly increases the proportion of heart failure patients achieving optimal GDMT doses and reduces time to optimization compared to standard clinic visits.
Remote titration with telemonitoring may accelerate optimal GDMT achievement in HF; extends this pilot RCT but requires larger trials for confirmation.
BACKGROUND: To improve health outcomes in patients with heart failure, guideline-directed medical therapy (GDMT) should be optimized to target doses. However, GDMT remains underutilized, with less than 25% of patients receiving target doses in clinical practice. Telemonitoring could provide reliable and real-time physiological data for clinical decision support to facilitate remote GDMT titration. OBJECTIVE: This paper aims to present findings from an internal pilot study regarding the effectiveness of remote titration facilitated by telemonitoring. METHODS: A 2-arm randomized controlled pilot trial comparing remote titration versus standard care in a heart function clinic was conducted. Patients were randomized to undergo remote medication titration facilitated by data from a smartphone-based telemonitoring system or standard titration performed during clinic visits. RESULTS: A total of 42 patients with new-onset (10/42, 24%) and existing (32/42, 76%) heart failure and a mean age of 55.29 (SD 11.28) years were randomized between January and June 2019. Within 6 months of enrollment, 86% (18/21) of patients in the intervention group achieved optimal doses versus 48% (10/21) of patients in the control group. The median time to dose optimization was 11.0 weeks for the intervention group versus 18.8 weeks for the control group. The number of in-person visits in the intervention group was 54.5% lower than in the control group. CONCLUSIONS: The results of this pilot study suggest that remote titration facilitated by telemonitoring has the potential to increase the proportion of patients who achieve optimal GDMT doses, decrease time to dose optimization, and reduce the number of clinic visits. Remote titration may facilitate optimal and efficient titration of patients with heart failure while reducing the burden for patients to attend in-person clinic visits. TRIAL REGISTRATION: ClinicalTrials.gov NCT04205513; https://clinicaltrials.gov/ct2/show/NCT04205513. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/preprints.19705.
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Artanian et al. (2020) conducted an RCT in Heart failure (n=42). Remote medication titration facilitated by smartphone-based telemonitoring vs. Standard clinic-based titration was evaluated on Achievement of target guideline-directed medical therapy doses within 6 months (p=0.004). Remote titration facilitated by telemonitoring significantly increased the proportion of heart failure patients achieving optimal guideline-directed medical therapy doses within 6 months (86% vs 48%) compared to standard care.
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