Challenge of Optimizing Medical Therapy in Heart Failure: Unlocking the Potential of Digital Health and Patient Engagement

eart failure (HF) is responsible for substantial morbidity among the estimated 6 million affected adults in the United States. 1 For HF with reduced ejection fraction (HFrEF), optimal guideline-directed medical therapy (GDMT) is estimated to reduce mortality by >70% in addition to improving quality of life. 1 However, GDMT remains underused.2,3 Therefore, there is a critical need to identify strategies to improve implementation of GDMT for patients with HF.HF remote monitoring programs have traditionally focused on lifestyle management, monitoring for signs of decompensation and diuretic adjustment rather than optimization of GDMT.The impact of such programs on clinical outcomes has been inconsistent.Given the clinical benefit of GDMT, focusing digital health interventions on medication optimization may improve their overall impact.4 In addition, interventions that have focused on improving HF medical therapy rates have traditionally focused on clinician or health system-level interventions, such as clinical decision support to encourage medication uptitration, implementation of pharmacist-or nurse-led titration protocols, and outpatient audit-and-feedback interventions.5,6 Many of these interventions have demonstrated effectiveness, but the magnitude of improvement in GDMT initiation and optimization has often been modest.2 For optimal HF management, patients ideally need to attend clinic visits, take and manage medications frequently, monitor vital signs and weight, adjust lifestyle, cope with HF stress, and participate in cardiac rehabilitation.However, there is little prior research on enhancing patient engagement to improve the use of GDMT.The EPIC-HF (Electronically Delivered, Patient-Activation Tool for Intensification of Medications for Chronic Heart Failure with Reduced Ejection Fraction) trial illustrated the potential of this paradigm.7 The trial randomized 306 outpatients with HFrEF to usual care or to receive patient activation tools, including a 3-minute video on the importance of GDMT and a 1-page paper checklist on GDMT goals.There was nearly a 20% absolute increase in GDMT initiation or intensification among the patient activation arm at 30 days.This illustrates that improving patient knowledge and motivation can substantially improve GDMT rates.Patient engagement is essential for virtual HF programs designed to optimize GDMT.8 Digital health