The impact of an adaptive patient-centered web application on medication optimization in patients with HFrEF: Rationale and design of the SmartHF trial

Introduction Heart failure (HF) remains a significant public health burden, with frequent readmissions often driven by a lack of guideline-directed medical therapy (GDMT) optimization. While clinical decision support (CDS) can improve healthcare processes, patient-centered tools that empower individuals to participate in their own care are increasingly needed. We developed SmartHF, an adaptive web application that provides patients with tailored HFrEF GDMT recommendations based on their clinical data. Methods This 12-week, multicenter randomized controlled trial enrolled adults with HFrEF (LVEF </=40%). Participants were randomized 1:1 to either the SmartHF intervention or usual care. The application uses a computable algorithm to integrate electronic health record (EHR) data, including medications, laboratory results, and vitals, via patient portal authorization. The primary endpoint is the change in a GDMT medication optimization score from baseline to Week 12. Results Enrollment concluded in August 2025 with a total of 225 participants. The study population had a mean age of 61.9 years, with 36% identifying as female and 52% as Black or African American. At baseline, 84% of participants were prescribed an ACEi/ARB/ARNI, 90% were on beta-blockers, 67% were prescribed an SGLT2i, while only 53% were on a mineralocorticoid receptor antagonist (MRA). The mean baseline medication optimization score was 68.5. Final trial results are expected in Winter 2026. Conclusions SmartHF is an innovative, low-touch digital health intervention that leverages EHR integration to facilitate patient-provider discussions on medication optimization. By providing personalized, guideline-based recommendations, the tool aims to improve GDMT prescribing in patients with HFrEF. Clinical Trials Registration ClinicalTrials.gov ID NCT05858320