EMAIL-HF: Can Digital Strategies Shorten the Path from Scientific Evidence to Clinical Practice in Heart Failure?

A substantial gap persists between scientific evidence and clinical practice in heart failure (HF). Digital solutions have emerged as promising strategies to accelerate the implementation of evidence-based therapies. This mini-review examines the results of the EMAIL-HF study, a registry-based, randomized, controlled, parallel-group clinical trial conducted in Denmark that included patients aged 20 years or older with a diagnosis of HF irrespective of left ventricular ejection fraction, who were not receiving SGLT2 inhibitors (SGLT2i). Participants were randomized to usual care or a digital strategy consisting of an e-mailed letter with information on SGLT2i, followed by contact with an HF specialist. The primary endpoint was the proportion of patients redeeming a prescription for dapagliflozin or empagliflozin within 6 months of randomization and the secondary endpoint was a composite of time to first HF hospitalization or death from any cause. The digital strategy significantly increased SGLT2i initiation within 6 months, although no difference in HF hospitalization or all-cause mortality was observed during the 24-month follow-up. Whether these strategies can translate modest improvements in treatment uptake into sustained, scalable, and cost-effective gains across diverse healthcare systems remains uncertain.