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Impact of Remote Titration Combined with Telemonitoring on the Optimization of Guideline Directed Medical Therapy for Patients with Heart Failure: Internal Pilot of a Randomized Controlled Trial
ABSTRACT
Background:
To improve health outcomes in heart failure patients, guideline directed medical therapy (GDMT) should be optimized to target doses. However, GDMT remains underutilized, with less than 25% of patients receiving target doses in clinical practice. Telemonitoring could provide reliable and real-time physiological data for clinical decision support to facilitate remote GDMT titration.
Objective:
This paper presents findings from an internal pilot study regarding the effectiveness of remote titration facilitated by telemonitoring.
Methods:
A 2-arm randomized controlled pilot trial comparing remote titration vs. standard heart function clinic care was conducted. Patients were randomized to undergo remote medication titration facilitated by data from a smartphone-based telemonitoring system, or standard titration performed during clinic visits.
Results:
42 patients with new onset (10 patients [23.8%]) and existing (32 patients [76.2%]) heart failure, mean age of 55.29 years (SD 11.28 years), were randomized between January and June 2019. Within 6 months of enrolment, 86% of patients in the intervention group achieved optimal doses vs. 48% of patients in the control group. The median time to dose optimization was 11.0 weeks for the intervention group vs. 18.8 weeks for the control group. The number of in-person visits in the intervention group was 54.5% lower than in the control group.
Conclusions:
The results of this pilot study suggest that remote titration facilitated by telemonitoring has the potential to increase the proportion of patients who achieve optimal GDMT doses, decrease time to dose optimization, and reduce the number of clinic visits. Remote titration may facilitate optimal and efficient titration of heart failure patients, while reducing the burden for patients to attend in-person clinic visits. Clinical Trial: ClinicalTrials.gov NCT04205513; https://clinicaltrials.gov/ct2/show/NCT04205513
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