Key result
Digital health intervention improves 90-day GDMT adherence and reduces hospitalizations in heart failure.
Why the study?
Digital health interventions may mitigate barriers to optimizing guideline-directed medical therapy for heart failure, such as infrequent clinical visits, clinician inertia, and poor patient knowledge, but evidence from low- and middle-income countries is limited.
Does a context-adapted digital health intervention improve guideline-directed medical therapy (GDMT) scores at 90 days compared with usual care in patients discharged after heart failure hospitalization in Brazil?
RCT (n=154)
Randomized
Yes
Does a context-adapted digital health intervention improve guideline-directed medical therapy (GDMT) scores at 90 days compared with usual care in patients discharged after heart failure hospitalization in Brazil?
In patients hospitalized for heart failure with LVEF <50% in Brazilian public hospitals, a multidisciplinary digital health intervention markedly improved 90-day GDMT optimization, self-care, and reduced hospitalizations compared with usual care.
Answers are grounded in this paper and cite their sources.
Supports adoption of context-adapted digital tools post-HF hospitalization in Brazil; extends RCT evidence on GDMT optimization to LMIC settings.
BACKGROUND: Barriers to optimizing guideline-directed medical therapy (GDMT) for heart failure include infrequent clinical visits, clinician inertia, and poor patient knowledge. Digital health interventions (DHIs) may mitigate these barriers, but evidence from low- and middle-income countries is limited. We evaluated whether a DHI would improve GDMT use and other outcomes in Brazil. METHODS: We enrolled adults admitted for heart failure with ejection fraction <50% and GDMT gaps (≥1 GDMT class not started or ≥2 classes ≤50% target dose) across 5 Brazilian public hospitals from November 2023 to August 2025. Participants were randomized to usual care or the DHI comprising a patient-facing app linked to a provider dashboard, supporting nurse-led remote monitoring, cardiologist teleconsultations, and self-care education. The primary outcome was the between-group difference in mean heart failure GDMT score (0-12) at 90 days. Secondary outcomes included differences in health status, self-care, hospitalization rates, and all-cause mortality. Intention-to-treat analyses used baseline-adjusted linear regression and estimated risk ratios. RESULTS: Among 154 randomized patients (DHI: 87; usual care: 67), mean age was 65±14 years; 62% were male, 66% were Black, 44% had ≤4 years of education, and 68% were New York Heart Association class III/IV. Primary outcome data were available for 141 participants (91.6%; DHI: 81; usual care: 60). Mean GDMT scores increased from 7.2 in both groups to 10.5 with DHI versus 7.5 with usual care at 90 days (changes: +3.3 versus +0.3 points; adjusted difference, 3.01 [95% CI, 2.30-3.73]; CONCLUSIONS: In patients hospitalized for heart failure in Brazil, a context-adapted DHI improved GDMT use, self-care, and reduced hospitalizations. These findings provide early randomized evidence supporting DHI for GDMT optimization in low-resource settings. REGISTRATION: URL: https://ensaiosclinicos.gov.br/rg/RBR-10vpf9bm; Unique identifier: U1111-1295-1864.
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Ciminelli et al. (2026) conducted an RCT in Heart failure with ejection fraction <50% (n=154). Digital health intervention (patient-facing app, provider dashboard, nurse-led remote monitoring, cardiologist teleconsultations, and self-care education) vs. Usual care was evaluated on Between-group difference in mean heart failure GDMT score (0-12) at 90 days (MD 3.01, 95% CI 2.30-3.73). A digital health intervention increased 90-day mean heart failure GDMT scores compared with usual care (10.5 vs 7.5; adjusted difference 3.01, 95% CI 2.30-3.73).
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