Currently submitted to: JMIR mHealth and uHealth
Date Submitted: Jul 28, 2026
Open Peer Review Period: Jul 30, 2026 - Sep 24, 2026
(currently open for review)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Mobile Health-Enabled Rapid Optimization of Guideline-Directed Medical Therapy in Acute Heart Failure: The TOM-HF Study
ABSTRACT
Background:
Delayed optimization of guideline-directed medical therapy (GDMT) after hospitalization for acute decompensated heart failure with reduced ejection fraction (HFrEF) remains common. Mobile health and telemonitoring platforms may help convert post-discharge medication titration from an episodic clinic-based process into a structured remote-care workflow.
Objective:
To evaluate the effectiveness and safety of the Telemonitoring to Optimize Medication for Heart Failure (TOM-HF) mobile health platform for remote GDMT titration after hospitalization for new-onset acute decompensated HFrEF.
Methods:
Adults hospitalized for HFrEF were prospectively enrolled in the Telemonitoring to Optimize Medication for Heart Failure (TOM-HF) study and followed for 12 weeks. Remote titration was delivered through a mobile health platform with algorithm-supported and specialist-adjudicated dosing decision. A 1:2 cardinality-matched historical cohort from the same centre’s heart failure registry served as the control group. The primary endpoint was the modified Heart Failure Collaboratory (mHFC) score, which is a standardized measure of heart failure GDMT intensity.
Results:
Overall, 28 TOM-HF participants were matched to 56 registry controls. The mHFC score was significantly higher in TOM-HF versus controls at discharge (64.3 vs 54.7; P=0.035), 4 weeks (98.2 vs 64.7; P<0.001), and 12 weeks (97.8 vs 69.2; P<0.001). Median time to maximally tolerated GDMT was 12 days (IQR 9–18) versus 82 days (IQR 23–90; log-rank P<0.001), with 100.0% versus 62.5% achieving maximally tolerated GDMT by 12 weeks. At 12 weeks, TOM-HF patients demonstrated greater improvements in 6-minute walk distance (+32.2% vs +23.6%; P<0.001), left ventricular ejection fraction (+21.7% vs +13.0%; P<0.001), and NT-proBNP (-90.8% vs -26.4%; P<0.001). Composite adherence was 83.2% (IQR, 76.5–91.4), and mean System Usability Scale score was 75.2. Hypotension was more frequent in TOM-HF, whereas serious adverse events were not increased.
Conclusions:
A mobile health-enabled remote titration strategy effectively and safely accelerated GDMT optimization after acute HFrEF hospitalization, warranting assessment in large-scale randomized trials. Clinical Trial: Trial registration number: NCT07016815
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